Clinical nurses’ experiences of providing ‘Internet+Nursing Services’ in public hospitals: a qualitative study in Western China

Clinical nurses’ experiences of providing ‘Internet+Nursing Services’ in public hospitals: a qualitative study in Western China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical nurses’ experiences of providing ‘Internet+Nursing Services’ in public hospitals: a qualitative study in Western China Yunling Long, Zhuo yuanyuan Chen, Yuling Xie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7593331/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background The "Internet + Nursing Service" (INS) is an innovative model developed in China to extend professional nursing care to home settings, particularly for elderly and chronically ill patients. Despite its potential to enhance healthcare accessibility, little is known about the experiences of clinical nurses who deliver these services, especially in Western China. Objective This study aimed to explore the experiences of clinical nurses participating in INS in a public tertiary hospital in Western China. Methods A qualitative descriptive study was conducted using semi-structured interviews with 12 clinical nurses who had completed at least five INS assignments. Data were analyzed using thematic analysis. Results Four main themes emerged: (1) Service value (professional growth, patient convenience, hospital reputation); (2) Practical barriers (logistical support, safety risks, procedural limitations); (3) Support needs (team collaboration, policy support); (4) Directions for improvement (process optimization, safety assurance, publicity expansion). Conclusion INS plays a critical role in enhancing continuity of care, but its sustainability requires systematic improvements in safety mechanisms, reimbursement policies, and publicity strategies. Support from hospitals, policymakers, and society is essential to optimize this service model. Clinical trial registration Not applicable. Internet + Nursing Services Nurse’s Experience Qualitative Research Thematic Analysis Home Care Services China Background Against the backdrop of global healthcare systems facing multiple challenges such as population aging, increasing burden of chronic diseases, and uneven distribution of medical resources, the importance of continuous nursing services has become increasingly prominent[ 1 , 2 ]. The deep integration of information technology and medical services has created opportunities for innovative nursing care models[ 3 ]. Against this background, "Internet + Nursing Services" (INS) has emerged as a new model that extends professional nursing services to communities and households through an "online application, offline service" approach, making it particularly suitable for discharged patients and those with limited mobility[ 4 ]. The Chinese government has attached great importance to the development of INS. In 2019, the National Health Commission of China launched a pilot program, designating Beijing, Tianjin, Shanghai, Jiangsu, Zhejiang, and Guangdong as pilot provinces/municipalities for "Internet + Nursing Services."This initiative encourages healthcare institutions to utilize registered nurses to provide in-home nursing care[ 5 ]. Subsequently, both the "Healthy China 2030" Plan[ 6 ] and the "14th Five-Year Plan" [ 7 ]for National Health emphasized the development of INS, promoting the construction of an integrated online-to-offline nursing model. As a major city in Western China, Chongqing has seen multiple hospitals implement INS. However, there remains a lack of in-depth research focusing on the real-world experiences of clinical nurses in this region who are involved in delivering these services. Based on Social Exchange Theory, as the direct providers of services, nurses' experiences and perceptions have a direct impact on service quality and sustainable development[ 8 ]. Nevertheless, existing studies have primarily focused on patient satisfaction or policy implementation outcomes, with limited attention devoted to understanding the challenges, support needs, and professional growth of nurses from their own perspectives. Therefore, this study employs a qualitative research approach to thoroughly explore the authentic experiences of clinical nurses participating in INS within tertiary hospitals in Western China. The aim is to identify both strengths and shortcomings in the current service model, thereby providing an empirical basis for optimizing service workflows, improving nurses’ working experience, and informing relevant policy-making. Participants Using a purposive sampling approach, clinical nurses who participated in the "Internet + Nursing Services" program at a Grade A tertiary hospital in Chongqing between February 2023 and December 2024 were selected as study participants. The inclusion criteria were as follows: (1) being a registered clinical nurse with a valid practicing certificate; (2) having at least 5 years of clinical nursing experience; (3) having provided "Internet + Nursing Services" to no fewer than 5 cases; (4) holding a professional title of Charge Nurse or above; (5) having engaged in the "Internet + Nursing Services" program for a minimum of 6 months; and (6) providing informed consent and voluntarily participating in the study.Exclusion criteria included: (1) nurses who were in training or advanced study programs; (2) those with a record of professional misconduct; and (3) individuals unwilling to participate in the research. The sample size was determined based on the principle of information saturation specific to qualitative studies [ 9 ]. Data saturation was considered achieved when no new themes emerged from three consecutive interviews. Ultimately, 12 participants were included and assigned sequential codes from N1 to N12. All twelve participants were female and held a Bachelor's degree in Nursing.Other general characteristics of the participants are presented in Table 1 . Table 1 Basic information about the sample (n = 12) No. Age (years) Title Department Years of Experience Number of "Internet + Nursing Services" Cases 1 40 Charge Nurse Urology Surgery 15 23 2 43 Charge Nurse Endocrinology 19 22 3 39 Charge Nurse General Medicine 20 22 4 42 Charge Nurse Gastrointestinal & Vascular Surgery 20 15 5 33 Charge Nurse Neurosurgery 15 14 6 36 Charge Nurse Gastrointestinal & Vascular Surgery 15 13 7 43 Charge Nurse Orthopedics 21 12 8 35 Charge Nurse Gastrointestinal & Vascular Surgery 13 8 9 43 Charge Nurse Orthopedics 20 7 10 33 Charge Nurse Integrated Chinese and Western Medicine 11 5 11 48 Associate Chief Nurse Rehabilitation & Pain Medicine 29 5 12 39 Charge Nurse Orthopedics 20 5 Research Methods This study employed a descriptive qualitative research approach, utilizing thematic analysis [ 10 ] as the core analytical tool. Data analysis was conducted following Braun & Clarke’s six-step framework for thematic analysis to explore the authentic work experiences of clinical nurses engaged in "Internet + Nursing Services" at a public Grade A tertiary hospital in Western China. Development of the Interview Guide Based on the research objectives and a review of the literature, a preliminary interview guide was drafted. The research team discussed and revised the guide, which was then reviewed by experts. Pre-interviews were conducted with two nurses who had provided "Internet + Nursing Services" on more than five occasions (these two nurses were not included in the final sample). The pre-interview results were used to further refine the guide to ensure it comprehensively captured nurses' work experiences in the program. During the pre-interviews, attention was paid to nurses’ descriptions of service processes, technology application, patient feedback, and personal perceptions. Common issues and key information were identified and served as focal points for the formal interviews. Additionally, the guide was adjusted based on shortcomings identified in the pre-interviews to enhance the relevance and effectiveness of the interviews. The detailed list of interviewoutline is presented in Table 2 . Table 2 Interview outline Question Outline 1 What are your views on "Internet + Nursing Services"? 2 What types of support do you hope to receive when providing these services? 3 What are your feelings (e.g., rewards, challenges) when delivering these services? 4 How has participating in this program affected your work? 5 How has participating in this program influenced your personal life? 6 What do you think is the significance of this program for patients/families and the hospital? 7 Have you encountered any unexpected situations while providing these services? How did you handle them, and what impact did they have on you? 8 What opinions or suggestions do you have regarding the implementation of this program at the hospital? 9 Is there anything else you would like to share with us about the program? Study Setting Beibei District is located in the northwest of Chongqing’s main urban area, serving as a hub for science, education, and culture, as well as an eco-friendly residential region. It has a permanent population of approximately 830,000, with an urbanization rate exceeding 85%, and an aging rate of 20.3% (higher than the municipal average). The population is relatively well-educated, with 32% holding a college degree or higher. The district is also well-equipped with medical resources, boasting 4.2 licensed physicians per 1,000 people [ 11 ]. This study was conducted at a Grade A tertiary general hospital in Beibei District. The hospital began preparations for the "Internet + Nursing Services" initiative in October 2022 and officially launched online order acceptance in February 2023. Services cover a wide range of areas, including clinical nursing, traditional Chinese medicine nursing, maternal and infant care, specialized nursing, rehabilitation nursing, and pediatric nursing. Specific services offered include venipuncture, indwelling catheter care, nasogastric tube care, blood glucose monitoring, PICC care, wound and stoma care, and infusion port maintenance, among others. As of December 2024, 17 nurses had participated in the "Internet + Nursing Services" program, completing a total of 171 orders. This hospital is the only Grade A tertiary general hospital in the region and serves as the primary provider of "Internet + Nursing Services" in the area. Although the program was launched later compared to pilot hospitals in other cities, it has demonstrated a relatively high and growing number of orders, along with a comprehensive range of services. It is noteworthy that, currently, there are no specific policy supports or safeguard mechanisms for such services in Chongqing. Data Collection Data were collected through face-to-face, semi-structured interviews with the participants. Prior to each interview, the researcher contacted eligible nurses via telephone or WeChat to schedule a suitable time. The purpose of the study, the voluntary nature of participation, and guarantees of confidentiality were explained to each participant. They were informed that the interview would be audio-recorded and that written informed consent was required. Interviews were conducted in a quiet meeting room free from interruptions. The interviewer began with neutral topics to help put participants at ease before gradually guiding the conversation according to the interview guide. A neutral stance was maintained throughout, and active listening techniques were employed to encourage detailed responses. Follow-up questions were used to elicit richer information. Non-verbal expressions, such as facial expressions and gestures, were also noted. The order of questions was adjusted flexibly based on the flow of the conversation. All interviews were conducted in a relaxed and natural atmosphere, with each session lasting between 30 and 40 minutes. Data Analysis Following each interview, the audio recordings were transcribed verbatim within 24 hours. The transcripts were cross-checked by two researchers and returned to the participants for verification. Thematic analysis was adopted for data analysis, conducted according to the following steps: ① Familiarization with the data: Repeated reading of transcripts and note-taking; ② Generating initial codes: Line-by-line or segment-by-segment coding to identify meaningful units and develop open codes; ③ Grouping codes into potential themes; ④ Reviewing themes: Examining the validity of candidate themes and their coverage of key aspects of the data; ⑤ Defining and naming themes: Refining and labeling each theme in clear, accessible language; ⑥ Writing the analysis: Synthesizing and reporting the thematic findings. Three researchers independently performed the analysis. Any discrepancies in coding or thematic identification were resolved through discussion until consensus was reached, thereby enhancing the objectivity and accuracy of the analysis. An example illustrating the process of initial code generation and theme development based on raw data is provided in Table 3 . Table 3 Example of Initial Code Generation and Theme Development Process Core Theme Subtheme Initial Code Raw Data Service Value Patient Benefits Patient Convenience "This home-visit service is very convenient for patients." (N4) Reduced Family Burden "It's difficult to move paralyzed patients; home service saves cost and effort." (N1) Improved Compliance "Teaching family members nursing techniques reduces follow-up visits." (N6) Nurse Professional Growth Enhanced Adaptability "I feel my adaptability has also improved." (N6) Skill Improvement "After providing home services, my catheterization technique became more proficient." (N8) Sense of Recognition "Patient recognition makes me more confident." (N4) Hospital Social Impact Enhanced Reputation "Patients from other hospitals were referred to our services." (N3) Increased Patient Trust "Patients actively promote the hospital's services." (N12) Ethical Considerations This study was approved by the Ethics Committee of Beibei Hospital of Chongqing Medical University in accordance with the principles of the Declaration of Helsinki (Approval No.: 2025-Science (Ethics)-016). Written informed consent, including permission for audio recording, was obtained from each participant. Results Analysis of interviews with 12 clinical nurses participating in the "Internet + Nursing Services" program revealed four key themes: service value, practical barriers, support needs, and directions for improvement. Theme 1: Service Value Enhanced Patient Convenience and Reduced Healthcare Burden Some participants indicated that the "Internet + Nursing Services" provided significant convenience for patients with limited mobility, reducing the transportation and human resource costs associated with hospital visits for both patients and their families. N1: "It is quite difficult to bring bedridden or mobility-impaired patients to the hospital—it requires considerable effort and expense." N4: "Every time I visit them at home, they are very grateful. They find it hard to move the patient to the hospital, especially going downstairs. This home service is very convenient for patients." N6: "It is very troublesome for vegetative patients to come to the hospital. Internet + Nursing Services offer them a convenient alternative." Professional Growth and Sense of Achievement Among Nurses Through home-visit services, nurses gained recognition from patients, which significantly enhanced their sense of professional achievement and self-confidence. Some nurses reported improved technical proficiency. N6: "I have improved my ability to respond to emergencies." N7: "Patients and families are very happy with the home service. Their happiness gives me a strong sense of accomplishment." N9: "I feel proud to provide nursing care at home. Patients are very grateful for the help, and that makes me feel fulfilled." N8: "Especially with nasogastric tube insertion—since starting home visits, my technique has become more skilled and steady." Enhanced Hospital Reputation and Patient Trust The "Internet + Nursing Services" program brought together core clinical and specialist nurses through an online platform, allowing them to fully utilize their professional expertise to deliver high-quality nursing care to home-based patients. This effort enhanced the hospital's reputation and patient satisfaction. N1: "I feel that overall patient satisfaction and positive feedback are very high." N4: "A patient who had been discharged from another hospital learned about our service and contacted me. After one visit, they trusted me completely and entrusted me with wound dressing and suture removal." N12: "When we visit patients' homes, they and their families are very welcoming—they even invited us to meals and showed great trust in us." Theme 2:Practical Barriers Systemic Barriers Systemic barriers stem from inadequate institutional design, resource allocation, and policy support, primarily manifested as insufficient logistical support, service coverage and cost limitations, and lack of promotion. In terms of logistical support, some interviewees mentioned difficulties in transportation, such as inconvenient travel and challenges returning after visits, especially from remote areas where finding return transportation was difficult, increasing personal financial and time burdens. Difficulties in human resource allocation within departments also arose, as home visits often conflicted with ward duties, requiring frequent shift changes and increasing departmental management pressure. Additionally, only one shared medical supply kit was available hospital-wide, making it inconvenient to access. N4: “The company car is set to depart from the hospital, but nurses on rest days have to come from home to the hospital to take the car. They can’t set off directly from home, which is very time-consuming. For very remote areas, after taking a car there, it’s very hard to find a ride back. For example, last time I went to Jinyun Mountain, there was no transportation back.” N5: “It’s hard to get a taxi in remote areas, so I have to drive myself, which increases my expenses. Sometimes I might be called in on my day off—I feel this affects my personal life.” N7: “Personally, I find it very troublesome to get the service kit from the hospital every time. Nurses in our department who do home visits use a kit prepared by the department—it’s much more convenient.” N8: “There are very few colleagues on duty in our ward. If I go out for a home visit, the ward will be short-staffed.” Regarding service coverage and cost limitations, the “Internet + Nursing Services” faces challenges due to geographical restrictions. These limitations prevent some patients in need from accessing services, highlighting a gap between service coverage and user demand. N8: “When he placed the order, it seemed his home was too far away—outside our service radius.” N10: “Currently, our hospital’s service radius is only about 10 kilometers. Some patients have these needs but live outside this range, so they can’t place orders.” Some interviewees also mentioned the high cost of “Internet + Nursing Services,” which places a heavy financial burden on patients. Currently, home-visit services are entirely out-of-pocket, contrasting sharply with the reimbursement policies for outpatient services. This leads some patients to forgo the service due to cost concerns. Many eligible patients, especially those requiring long-term care such as stoma patients, choose to visit the hospital in person due to price factors. The high cost has become a major barrier to the wider adoption of Internet-based nursing services, underscoring an urgent need to explore integration with health insurance systems to alleviate financial pressure on patients and improve service accessibility and acceptance. N8: “Many of our stoma patients don’t place orders online—they come directly to our ward. They feel it’s more expensive to order online.” N9: “I wish the price could be a bit lower. Once we had a patient who was very suitable for home service, but after we mentioned the price, he hesitated and didn’t choose it. Every time, he brought the patient to the hospital.” N10: “Internet + Nursing Services may become the norm in the future, but the cost is a bit high for patients, especially with high demand. Including material fees, it might be slightly expensive.” In terms of promotion, there is a significant unmet demand for “Internet + Nursing Services.” Current promotion efforts are clearly insufficient, with most patients learning about the service through word of mouth or by chance, reflecting a lack of systematic outreach. Many patients with nursing needs only become aware of the home service after extensive inquiries, indicating limited dissemination and penetration of service information. This is especially true for specialized nursing items such as indwelling gastric or urinary catheters, which have low public awareness, creating an information gap between potential demand and actual service supply. This low level of awareness severely limits the popularization and effectiveness of “Internet + Nursing Services.” N3: “Many patients only learned that our hospital offers Internet + Nursing Services after asking around repeatedly.” N8: “They don’t know that our hospital can provide home services like indwelling gastric or urinary catheterization. I think promotion efforts need significant improvement—many people are simply unaware.” N12: “One patient I visited last time said he hadn’t known our hospital offered home services—he only found out through another patient.” Operational Barriers Operational barriers involve procedural shortcomings and safety risks during service delivery, mainly reflected in significant safety concerns and flaws in process design. Regarding safety risks, some interviewees reported that safety was a major concern. First, nurses enter unfamiliar environments alone to provide services without prior knowledge of the patient’s family background or household composition, posing potential safety risks. Second, they may encounter service recipients with harmful social habits or unstable emotions, increasing threats to their personal safety. Third, technical difficulties or unsatisfactory treatment outcomes during procedures can easily trigger anxiety among family members, potentially leading to aggressive behavior. These safety concerns highlight urgent needs for improvement in risk assessment, safety protection, and emergency response mechanisms in “Internet + Nursing Services.” N1: “I think safety is a very important consideration when I provide home visits alone. We enter an unfamiliar environment without knowing the specifics.” N6: “For example, once I visited a family where the patient was an elderly woman, and her husband was kind, but all their children were drug users—long-haired, smoking, both men and women. It was terrifying, and I was worried about my safety.” N8: “Once, when inserting a gastric tube, the guidewire couldn’t be removed. I was very anxious, and the family was also very worried. That visit took a long time—it took three attempts to successfully place the tube. I was concerned the family might become aggressive.” N10: “Another issue is not knowing the patient’s background—could they have severe social habits? We have no idea about these aspects until we arrive. So, safety is a worry.” In terms of process design, “Internet + Nursing Services” faces multiple limitations. First, the singular qualification requirements for nurses reduce service efficiency—multiple care needs from the same patient often require separate visits by differently qualified nurses, leading to wasted human resources and increased service costs. Second, the lack of standardized management for nursing supplies means different nurses bring different brands and models of materials, affecting patient experience and treatment continuity. Third, the current 24-hour advance booking mechanism struggles to meet urgent care needs, such as blocked urinary catheters, causing unnecessary patient suffering. These procedural limitations highlight the need for optimization in flexibility, response speed, and resource integration within the current service model. N10: “For example, if a patient is used to a certain type of gastric or urinary catheter and finds it works well, but the nursing department doesn’t necessarily assign the same nurse every time, the materials brought may differ, and the patient finds it inconvenient.” N9: “I encountered a situation where the same patient ordered both urinary and gastric tube services. On the platform, I only have qualifications for catheterization, while another nurse is qualified for gastric tube insertion. So, two nurses from different departments were sent—one for the gastric tube, one for the urinary catheter. It would be better if one nurse could have multiple qualifications and be sent alone. Sending two people for two procedures is a waste of manpower and time.” N7: “In fact, every nurse is capable of performing these procedures. If a patient needs both a urinary catheter and a gastric tube, they could choose the same nurse for multiple services, which could also save costs.” N1: “From the patient’s perspective, the 24-hour advance booking requirement is problematic. For example, if a urinary catheter is suddenly blocked and the patient’s bladder has been distended for hours, making them wait 24 hours for a home visit is a painful process. It also poses safety risks. I think the 24-hour requirement could be reduced to 8 hours, or there could be an expedited option based on the patient’s condition.” Theme 3:Support Needs Team Collaboration Some interviewees emphasized the need for collaborative support from head nurses, colleagues, and specialized physicians when participating in "Internet + Nursing Services." Optimizing human resource allocation through flexible scheduling and strengthening multidisciplinary team building were highlighted as essential to addressing cross-disciplinary challenges. N1: "I always try to go with a resident trainee. Having two people for home visits ensures safety and also helps the trainee learn about the service." N9: "We need support from doctors. Sometimes we bring a doctor along to examine a patient’s wound." N12: "When I need to go out during work hours, I have to ask the head nurse to adjust my schedule and arrange cover. Once, I encountered a patient with prostate hyperplasia during catheterization. It was difficult and I didn’t succeed. I communicated with a urology doctor, who recommended that the patient see a specialist at the hospital." Policy Support Policy support needs for "Internet + Nursing Services" primarily focus on cost reimbursement mechanisms. Currently, home-based nursing services are entirely self-paid, creating a significant disparity with outpatient services that are eligible for insurance reimbursement. N9: "It would be great if our service fees could be covered by health insurance." N11: "For example, if it could be linked to medical insurance so patients don’t have to pay out-of-pocket, the service might be more readily accepted. Currently, outpatient services are reimbursable." N12: "Right now, home visits are completely self-paid, while outpatient care is partially reimbursed. I wonder if it’s possible in the future to link online orders with insurance to reduce the financial burden on patients." N8: "Support from the national government is needed. Including these costs in health insurance could alleviate financial pressure on the public." Theme 4:Directions for Improvement Several interviewees suggested that optimizing service processes, strengthening promotion, expanding services, and enhancing safety measures are key areas for improvement in "Internet + Nursing Services." Systematic optimization would improve efficiency, safety, and accessibility to meet diverse patient needs. N1: "We could focus on promoting the service in welfare institutions and nursing homes—they have greater demand for home visits." N3: "Regular seminars should be held to share experiences and learn better ways to handle different situations. Better communication among staff is needed." N4: "The company car arrangement should be optimized to allow nurses to start from home." N6: "We could coordinate within the department to have a intern accompany and assist during visits." N7: "Personally, I find fetching the kit troublesome, so I prepared one in our department. The home visit procedure could be more detailed, and annual training should be organized. When suture removal is needed, we should bring a doctor." N8: "If the same patient orders both urinary and gastric tube services, only one nurse should be assigned. The cost for a home visit is quite high, and some patients cannot afford it. Insurance coverage would definitely reduce the cost burden." N10: "We should consider expanding the service range. Families with concerning social habits or history of drug use should be flagged in the system. The nursing department should clearly inform nurses and emphasize safety precautions. Bringing one or two interns, preferably male students, would be helpful." N12: "I feel a bit nervous going alone, so I always take an intern from the department. Whenever possible, I bring a male student with me." Discussion The Critical Role of "Internet + Nursing Services" in Improving Healthcare Accessibility By enabling online appointments and home visits, "Internet + Nursing Services" breaks the constraints of traditional medical care models, allowing homebound patients to receive professional nursing care at home. This approach benefits not only patients and their families but also nurses and hospitals. It offers significant convenience to service recipients, helps establish positive nurse-patient relationships, improves hospital efficiency, facilitates convenient patient care, and gains recognition from patients [ 12 – 13 ]. It also saves time and human costs for patients and families [ 14 ], while helping nurses achieve self-fulfillment and a sense of accomplishment [ 15 ]. This study demonstrates that the service greatly facilitates patients with limited mobility, reduces transportation and human resource costs for families, and alleviates the overall burden associated with hospital visits. At the same time, nurses gain professional growth and satisfaction through their participation, and hospitals enhance their reputation while increasing patient trust and satisfaction. The service meets diverse nursing needs, covering areas such as catheterization, wound dressing, stoma care, and rehabilitation training, thereby supporting patients from acute phases through recovery. By shifting certain nursing services from the hospital to the home, it reduces pressure on hospital bed turnover, optimizes the allocation of medical resources, and shortens hospital stays to some extent. Optimizing Service Processes to Improve Efficiency "Internet + Nursing Services" requires that nurses possess appropriate qualifications and pass training assessments before providing continuous care to residents[ 15 ]. As the managing body, the nursing department should regularly organize skill training and encourage nurses to obtain qualifications in multiple procedures, such as catheterization, venipuncture, and nasogastric tube care. This can reduce the need for dispatching multiple nurses for a single patient with complex needs, thereby improving service efficiency and reducing labor costs. Chen Yanling et al.[ 16 ] highlighted the importance of establishing multidisciplinary collaboration mechanisms for professional guidance. Medical institutions should form multidisciplinary support teams that include physicians, enabling online nurses to obtain real-time guidance via voice or video calls. Building multidisciplinary medical teams tailored to the features of "Internet + Nursing Services" allows both online consultation and offline home visits, addressing diverse patient needs[ 12 ], enhancing the professionalism and safety of nursing services, and reducing the need for follow-up visits or transfers due to operational challenges. Thorough Safety Risk Assessment to Protect Nurses Nurses from hospitals of different levels consistently report safety concerns as a major factor hindering the development of "Internet + Nursing Services" [ 17 ]. In this study, nurses’ safety concerns align with findings from Li Yuan et al.[ 18 ] and Zhang Jiayan et al.[ 19 ]. The personal safety of online nurses during home visits is a significant risk, making it essential to understand potential safety incidents and their handling during service delivery. Risk prevention should be prioritized over post-incident response, and preventive awareness must be emphasized to mitigate risks[ 20 ]. In addition to implementing strict access assessments for service items, it is crucial to evaluate the service recipient and home environment in advance, ideally after the patient books the appointment but before the visit. International practices, such as using a home environment assessment checklist[ 21 ], can be adopted for systematic evaluation. Nurses should also be provided with necessary protective measures, such as GPS alert devices and workflow recorders, to minimize safety risks[ 22 ]. Strengthening Promotion to Increase Public Awareness and Benefit More Recipients Although there is substantial demand for "Internet + Nursing Services," public awareness remains limited. Many are either unaware of the service or do not know how to access it, which restricts its broader adoption. Survey results from Zhao Ying et al.[ 23 ] show that patients lack understanding of the operational model, documentation, and information platforms related to the service. Older adults, in particular, have limited access to information and primarily learn through traditional media such as newspapers and television[ 24 ]. Therefore, multipronged promotional strategies are recommended: ①Online channels: Introduce the service through hospital websites, official WeChat accounts, and short-video platforms (e.g., Douyin, Kuaishou) with service descriptions, user guides, and success stories. ②Offline channels: Distribute brochures, display posters in nurse stations and outpatient halls, and hold patient conferences within hospital departments. Externally, organize health talks or free clinics in communities and nursing homes to promote the service face-to-face among key populations. ③Media collaboration: Partner with local TV stations, radio channels, and magazines to produce feature programs and public service announcements, expanding social impact. Seeking Government Reimbursement Policy Support to Ensure Sustainable Development Interviews revealed that although "Internet + Nursing Services" offers many benefits, some patients are deterred by the cost. Zhao Ying et al.[ 17 ] suggest that government agencies and hospitals set reasonable prices based on the complexity and duration of services. While incentivizing nurses from different levels of hospitals to actively participate, cooperative payment methods such as health insurance could be introduced to reduce patient costs, truly fulfilling the government’s goal of accessible services. Yin Shiyu et al.[ 25 ] and Wang Chong et al.[ 26 ] recommend that medical insurance authorities include certain nursing services in the reimbursement system and support online payment to reduce user burden and improve convenience. Li Xia [ 13 ] and Gao Yumeng[ 27 ] propose integrating "Internet + Nursing Services" into long-term care insurance with proportional reimbursement. Internationally, Australia’s social health insurance covers part of home-visit costs, while countries such as Japan, the United States, and the United Kingdom allow long-term care insurance to pay for home nursing services[ 28 ]. In China, Ningbo, Zhejiang Province, included three home medical nursing items—peripherally inserted central catheter maintenance, indwelling urinary catheter care, and nasogastric tube care—in health insurance coverage in December 2021, with at-home payment supported[ 29 ]. It is urged that provinces and cities gradually incorporate "Internet + Nursing Services" fees into medical insurance or long-term care insurance reimbursement systems to alleviate financial pressure on patients and promote sustainable development of the service. We strongly recommend that other provinces and municipalities accelerate policy innovation to include "Internet + Nursing Services" within public insurance schemes. Such measures will not only reduce out-of-pocket expenses for patients but also provide a stable, sustainable funding mechanism, facilitating broader adoption and system-wide implementation of digital nursing services. Conclusion This study highlights that while "Internet + Nursing Services" offer significant benefits to patients, nurses, and hospitals, its sustainability is challenged by operational barriers, safety risks, limited awareness, and lack of reimbursement mechanisms. To enhance service quality and nurse satisfaction, we recommend optimizing workflows, strengthening safety protocols, expanding targeted promotion, and advancing insurance integration. Future efforts should develop patient-centered, nurse-safe home care models through multi-stakeholder collaboration. Limitations include single-center sampling; further multi-center and quantitative studies are needed to support policy-making and scalability. Abbreviations INS Internet+Nursing Service Declarations Acknowledgements We extend our sincere gratitude to all nurses who participated in the "Internet + Nursing Services" initiative and shared their valuable experiences and insights gained throughout their engagement in this program. Author contributions We declare that all authors meet the criteria for authorship and have approved the final article, and that all those entitled to authorship are listed as authors.Study design: Zhuoyuanyuan Chen; Development of interview guide: Zhuoyuanyuan Chen, Yunling Long; Data collection and analysis: Zhuoyuanyuan Chen, Yunling Long, Yuling Xie; Manuscript writing: Zhuoyuanyuan Chen, Yunling Long; Review and editing: Zhuoyuanyuan Chen, Yuling Xie. Funding Chongqing Municipal Education Commission's 14th Five-Year Key Discipline Support Project Data availability The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Ethical Approval This study was approved by the Ethics Committee of Beibei Hospital of Chongqing Medical University in accordance with the principles of the Declaration of Helsinki (Approval No.: 2025-Science (Ethics)-016). Written informed consent, including permission for audio recording, was obtained from each participant. Consent for Publication Not applicable. Competing Interests The authors declare that they have no competing interests. References Wang W, Liu L. Advances in the application of human-machine collaboratio-n in healthcare: insights from China. Front Public Health. 2025;13:1507142. doi:10.3389/fpubh.2025.1507142. Genovese G, Rizzo CE, Nirta A, et al. Mapping Healthcare Needs: A Systematic Review of Population Stratification Tools. Med Sci (Basel). 2025;13(3):145. doi:10.3390/medsci13030145. Notice of the General Office of the National Health Commission on Further Strengthening Nursing Work in Medical Institutions.https://www.nhc.gov.cn/wjw/c100175/202009/f808fa44796745cea65d5f7284f0bc18.shtml Accessed 8 Sept 2025. Li N, Pan WY. How Can "One-Click Booking" for Home Nursing Services Be Both Popular and Sustainable? Workers' Daily. 2025 May 24; Sect.002.doi:10.28277/n.cnki.ngrrb.2025.003499. Notice of the General Office of the National Health Commission on Launchi-ng the Pilot Program of "Internet + Nursing Services". https://www.gov.cn/zhen-gce/zhengceku/2019-10/08/content_5436955.htm. Accessed 3 May 2025. "Healthy China 2030" Planning Outline. https://www.gov.cn/zhengce/202203/c-ontent_3635233.htm. Accessed 8 Sept 2025. The 14th Five-Year Plan for National Health. https://www.gov.cn/zhengce/zh-engceku/2022-05/20/content_5691424.htm. Accessed 14 April 2025. Wu PP, Li QJ, Hong S, et al. A study on nurses’ organizational citizenship behavior based on social exchange theory. Nurs Res. 2013;27(31):3466–3467. Yang LP, Qi LD, Zhang B. Data saturation and its determination in qualitat-ive research. Adv Psychol Sci. 2022;30(3):511–521. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psyc-hol. 2006;3(2):77–101. doi:10.1191/1478088706qp063oa. Beibei District People's Government. Beibei District Government Portal. http://www.beibei.gov.cn. Accessed Accessed 8 April 2025. Shi SF, Wu DH, Ji LL. Experiences of primary hospital nurses conducting 'Internet+Nursing Services' under the medical consortium model. J Nurs Sci. 2024;39(3):100–102,107. Li X, Wang YP, Bai Y, et al. A qualitative study on nurses’ practical exp-eriences in 'Internet+Nursing Services'. Chin Nurs Manag. 2020;20(11):1662–1666. Fang TL, Liu LH, Chen J, et al. Nurses’ service experience in the initial stage of 'Internet+Nursing Services'. Chin Nurs Manag. 2022;22(8):1253–1257. Wang LT, Tang LJ, Yue LC, et al. A study on nurses’ working experience in Internet-based home nursing services. Chin J Nurs. 2020;55(7):1067–1071. Chen YL, Yang QH, Yu HY, et al. A qualitative study on the work experience of online appointment nurses under the background of 'Internet+Nursing Services'. J Nurs Sci. 2022;37(10):64–67. Zhao Y, Zhao Q. Analysis and improvement strategies for 'Internet+Nursing Services' in Shanghai based on NVivo. Nurs Res. 2024;38(1):1–7. Li A, Pang Y, Lin FC, et al. Preliminary construction and practice of an Internet+postpartum rehabilitation nursing studio. J Nurs Sci. 2020;35(12):12–15. Zhang JY, Zhao Y. A survey on the current status of 'Internet+Nursing Se-rvices' provided by hospital nurses in Shanghai. Nurs Res. 2022;36(19):3508–3512. Zhu J, Zhang R, Zhang LL, et al. A qualitative study on training needs and content for emergency response capacity of online appointment nurses. Nurs Res. 2024;38(8):1450–1454. Liu YB, Hou P, Xue HP, Mao XE, Li YN. Social Support, Health Literacy, and Health Care Utilization Among Older Adults. Asia Pac J Public Health.2019;31(4):359–366. doi:10.1177/1010539519851674. Yu J, Huang J, Li C, Zhuang Y. Barriers to clinical nurse participation in the internet-based home visiting program: a qualitative study. BMC Nurs. 2023;22(1):486. doi:10.1186/s12912-023-01651-9. Zhao Y, Qian WH, Zhao Q. A mixed-methods study on occupational safety and coping strategies of nurses under the background of 'Internet+Nursing Ser-vices'. J Nurs Train.2023;38(7):607–611. Zhao B, Zhang X, Huang R, Yi M, Dong X, Li Z. Barriers to accessing internet-based home care for older patients: a qualitative study. BMC Geriatr. 2021;21(1):565. doi:10.1186/s12877-021-02474-6. Yin SY, Wang Y, Xu R, et al. A survey on the current status of 'Internet+Nursing Services' in 202 hospitals. J Nurs Sci. 2024;39(23):57–60,97. Wang C, Shi DF, Xie TF, et al. A qualitative study on the real experience of enterostomy patients with 'Internet + In-home Nursing Services'. J Nurs Sci. 2023;38(20):8–11. Gao YM, Zhao H, Li X, et al. A Meta-synthesis of qualitative studies on nurses’ experience with 'Internet+Nursing Services' in China. J Nurs Sci. 2022;37(11):87–91. Jiang XL, Zhang L, Xiang X. Current status and implications of foreign 'Internet+Nursing' home service models. Chin Health Qual Manag. 2021;28(10):16–20. Xu Q, Hu JL, Guo XL, et al. Practice of medical insurance home payme-nt for 'Internet+Nursing Services' in Ningbo. Chin J Hosp Adm. 2023;39(7):546–549. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7593331","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":536929201,"identity":"81befacb-fbb0-4805-89c8-4b2198480df5","order_by":0,"name":"Yunling Long","email":"","orcid":"","institution":"Beibei Hospital of Chongqing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yunling","middleName":"","lastName":"Long","suffix":""},{"id":536929202,"identity":"e4e85a1c-86e8-4f84-8b3d-4ad9cb6aa612","order_by":1,"name":"Zhuo yuanyuan 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The deep integration of information technology and medical services has created opportunities for innovative nursing care models[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Against this background, \"Internet + Nursing Services\" (INS) has emerged as a new model that extends professional nursing services to communities and households through an \"online application, offline service\" approach, making it particularly suitable for discharged patients and those with limited mobility[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Chinese government has attached great importance to the development of INS. In 2019, the National Health Commission of China launched a pilot program, designating Beijing, Tianjin, Shanghai, Jiangsu, Zhejiang, and Guangdong as pilot provinces/municipalities for \"Internet + Nursing Services.\"This initiative encourages healthcare institutions to utilize registered nurses to provide in-home nursing care[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Subsequently, both the \"Healthy China 2030\" Plan[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and the \"14th Five-Year Plan\" [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]for National Health emphasized the development of INS, promoting the construction of an integrated online-to-offline nursing model. As a major city in Western China, Chongqing has seen multiple hospitals implement INS. However, there remains a lack of in-depth research focusing on the real-world experiences of clinical nurses in this region who are involved in delivering these services.\u003c/p\u003e\u003cp\u003eBased on Social Exchange Theory, as the direct providers of services, nurses' experiences and perceptions have a direct impact on service quality and sustainable development[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Nevertheless, existing studies have primarily focused on patient satisfaction or policy implementation outcomes, with limited attention devoted to understanding the challenges, support needs, and professional growth of nurses from their own perspectives. Therefore, this study employs a qualitative research approach to thoroughly explore the authentic experiences of clinical nurses participating in INS within tertiary hospitals in Western China. The aim is to identify both strengths and shortcomings in the current service model, thereby providing an empirical basis for optimizing service workflows, improving nurses’ working experience, and informing relevant policy-making.\u003c/p\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003e Using a purposive sampling approach, clinical nurses who participated in the \"Internet + Nursing Services\" program at a Grade A tertiary hospital in Chongqing between February 2023 and December 2024 were selected as study participants. The inclusion criteria were as follows: (1) being a registered clinical nurse with a valid practicing certificate; (2) having at least 5 years of clinical nursing experience; (3) having provided \"Internet + Nursing Services\" to no fewer than 5 cases; (4) holding a professional title of Charge Nurse or above; (5) having engaged in the \"Internet + Nursing Services\" program for a minimum of 6 months; and (6) providing informed consent and voluntarily participating in the study.Exclusion criteria included: (1) nurses who were in training or advanced study programs; (2) those with a record of professional misconduct; and (3) individuals unwilling to participate in the research.\u003c/p\u003e\u003cp\u003eThe sample size was determined based on the principle of information saturation specific to qualitative studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Data saturation was considered achieved when no new themes emerged from three consecutive interviews. Ultimately, 12 participants were included and assigned sequential codes from N1 to N12. All twelve participants were female and held a Bachelor's degree in Nursing.Other general characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBasic information about the sample (n = 12)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTitle\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDepartment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYears of Experience\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNumber of \"Internet + Nursing Services\" Cases\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCharge Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUrology Surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCharge Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEndocrinology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCharge Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGeneral Medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCharge Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGastrointestinal \u0026amp; Vascular Surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCharge Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNeurosurgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCharge Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGastrointestinal \u0026amp; Vascular Surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCharge Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOrthopedics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCharge Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGastrointestinal \u0026amp; Vascular Surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCharge Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOrthopedics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCharge Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIntegrated Chinese and Western Medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAssociate Chief Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRehabilitation \u0026amp; Pain Medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCharge Nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOrthopedics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\n\n\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\n\n\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Research Methods","content":"\u003cp\u003eThis study employed a descriptive qualitative research approach, utilizing thematic analysis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] as the core analytical tool. Data analysis was conducted following Braun \u0026amp; Clarke’s six-step framework for thematic analysis to explore the authentic work experiences of clinical nurses engaged in \"Internet + Nursing Services\" at a public Grade A tertiary hospital in Western China.\u003c/p\u003e\u003ch3\u003eDevelopment of the Interview Guide\u003c/h3\u003e\u003cp\u003eBased on the research objectives and a review of the literature, a preliminary interview guide was drafted. The research team discussed and revised the guide, which was then reviewed by experts. Pre-interviews were conducted with two nurses who had provided \"Internet + Nursing Services\" on more than five occasions (these two nurses were not included in the final sample). The pre-interview results were used to further refine the guide to ensure it comprehensively captured nurses' work experiences in the program.\u003c/p\u003e\u003cp\u003eDuring the pre-interviews, attention was paid to nurses’ descriptions of service processes, technology application, patient feedback, and personal perceptions. Common issues and key information were identified and served as focal points for the formal interviews. Additionally, the guide was adjusted based on shortcomings identified in the pre-interviews to enhance the relevance and effectiveness of the interviews. The detailed list of interviewoutline is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInterview outline\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOutline\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat are your views on \"Internet + Nursing Services\"?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat types of support do you hope to receive when providing these services?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat are your feelings (e.g., rewards, challenges) when delivering these services?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow has participating in this program affected your work?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHow has participating in this program influenced your personal life?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat do you think is the significance of this program for patients/families and the hospital?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHave you encountered any unexpected situations while providing these services? How did you handle them, and what impact did they have on you?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat opinions or suggestions do you have regarding the implementation of this program at the hospital?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIs there anything else you would like to share with us about the program?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch3\u003eStudy Setting\u003c/h3\u003e\u003cp\u003eBeibei District is located in the northwest of Chongqing’s main urban area, serving as a hub for science, education, and culture, as well as an eco-friendly residential region. It has a permanent population of approximately 830,000, with an urbanization rate exceeding 85%, and an aging rate of 20.3% (higher than the municipal average). The population is relatively well-educated, with 32% holding a college degree or higher. The district is also well-equipped with medical resources, boasting 4.2 licensed physicians per 1,000 people [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis study was conducted at a Grade A tertiary general hospital in Beibei District. The hospital began preparations for the \"Internet + Nursing Services\" initiative in October 2022 and officially launched online order acceptance in February 2023. Services cover a wide range of areas, including clinical nursing, traditional Chinese medicine nursing, maternal and infant care, specialized nursing, rehabilitation nursing, and pediatric nursing. Specific services offered include venipuncture, indwelling catheter care, nasogastric tube care, blood glucose monitoring, PICC care, wound and stoma care, and infusion port maintenance, among others.\u003c/p\u003e\u003cp\u003eAs of December 2024, 17 nurses had participated in the \"Internet + Nursing Services\" program, completing a total of 171 orders. This hospital is the only Grade A tertiary general hospital in the region and serves as the primary provider of \"Internet + Nursing Services\" in the area. Although the program was launched later compared to pilot hospitals in other cities, it has demonstrated a relatively high and growing number of orders, along with a comprehensive range of services. It is noteworthy that, currently, there are no specific policy supports or safeguard mechanisms for such services in Chongqing.\u003c/p\u003e\u003ch3\u003eData Collection\u003c/h3\u003e\u003cp\u003eData were collected through face-to-face, semi-structured interviews with the participants. Prior to each interview, the researcher contacted eligible nurses via telephone or WeChat to schedule a suitable time. The purpose of the study, the voluntary nature of participation, and guarantees of confidentiality were explained to each participant. They were informed that the interview would be audio-recorded and that written informed consent was required.\u003c/p\u003e\u003cp\u003eInterviews were conducted in a quiet meeting room free from interruptions. The interviewer began with neutral topics to help put participants at ease before gradually guiding the conversation according to the interview guide. A neutral stance was maintained throughout, and active listening techniques were employed to encourage detailed responses. Follow-up questions were used to elicit richer information. Non-verbal expressions, such as facial expressions and gestures, were also noted.\u003c/p\u003e\u003cp\u003eThe order of questions was adjusted flexibly based on the flow of the conversation. All interviews were conducted in a relaxed and natural atmosphere, with each session lasting between 30 and 40 minutes.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eFollowing each interview, the audio recordings were transcribed verbatim within 24 hours. The transcripts were cross-checked by two researchers and returned to the participants for verification. Thematic analysis was adopted for data analysis, conducted according to the following steps:\u003c/p\u003e\u003cp\u003e① Familiarization with the data: Repeated reading of transcripts and note-taking;\u003c/p\u003e\u003cp\u003e② Generating initial codes: Line-by-line or segment-by-segment coding to identify meaningful units and develop open codes;\u003c/p\u003e\u003cp\u003e③ Grouping codes into potential themes;\u003c/p\u003e\u003cp\u003e④ Reviewing themes: Examining the validity of candidate themes and their coverage of key aspects of the data;\u003c/p\u003e\u003cp\u003e⑤ Defining and naming themes: Refining and labeling each theme in clear, accessible language;\u003c/p\u003e\u003cp\u003e⑥ Writing the analysis: Synthesizing and reporting the thematic findings.\u003c/p\u003e\u003cp\u003eThree researchers independently performed the analysis. Any discrepancies in coding or thematic identification were resolved through discussion until consensus was reached, thereby enhancing the objectivity and accuracy of the analysis. An example illustrating the process of initial code generation and theme development based on raw data is provided in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eExample of Initial Code Generation and Theme Development Process\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCore Theme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubtheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInitial Code\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRaw Data\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eService Value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient Benefits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePatient Convenience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\"This home-visit service is very convenient for patients.\" (N4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReduced Family Burden\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\"It's difficult to move paralyzed patients; home service saves cost and effort.\" (N1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eImproved Compliance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\"Teaching family members nursing techniques reduces follow-up visits.\" (N6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNurse Professional Growth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEnhanced Adaptability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\"I feel my adaptability has also improved.\" (N6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSkill Improvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\"After providing home services, my catheterization technique became more proficient.\" (N8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSense of Recognition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\"Patient recognition makes me more confident.\" (N4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHospital Social Impact\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEnhanced Reputation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\"Patients from other hospitals were referred to our services.\" (N3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIncreased Patient Trust\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\"Patients actively promote the hospital's services.\" (N12)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003eEthical Considerations\u003c/h2\u003e\u003cp\u003e This study was approved by the Ethics Committee of Beibei Hospital of Chongqing Medical University in accordance with the principles of the Declaration of Helsinki (Approval No.: 2025-Science (Ethics)-016). Written informed consent, including permission for audio recording, was obtained from each participant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAnalysis of interviews with 12 clinical nurses participating in the \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" program revealed four key themes: service value, practical barriers, support needs, and directions for improvement.\u003c/p\u003e\n\u003ch3\u003eTheme 1: Service Value\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eEnhanced Patient Convenience and Reduced Healthcare Burden\u003c/h2\u003e\u003cp\u003eSome participants indicated that the \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" provided significant convenience for patients with limited mobility, reducing the transportation and human resource costs associated with hospital visits for both patients and their families.\u003c/p\u003e\u003cp\u003eN1: \"It is quite difficult to bring bedridden or mobility-impaired patients to the hospital\u0026mdash;it requires considerable effort and expense.\"\u003c/p\u003e\u003cp\u003eN4: \"Every time I visit them at home, they are very grateful. They find it hard to move the patient to the hospital, especially going downstairs. This home service is very convenient for patients.\"\u003c/p\u003e\u003cp\u003eN6: \"It is very troublesome for vegetative patients to come to the hospital. Internet\u0026thinsp;+\u0026thinsp;Nursing Services offer them a convenient alternative.\"\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eProfessional Growth and Sense of Achievement Among Nurses\u003c/h2\u003e\u003cp\u003eThrough home-visit services, nurses gained recognition from patients, which significantly enhanced their sense of professional achievement and self-confidence. Some nurses reported improved technical proficiency.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eN6: \"I have improved my ability to respond to emergencies.\"\u003c/h2\u003e\u003cp\u003eN7: \"Patients and families are very happy with the home service. Their happiness gives me a strong sense of accomplishment.\"\u003c/p\u003e\u003cp\u003eN9: \"I feel proud to provide nursing care at home. Patients are very grateful for the help, and that makes me feel fulfilled.\"\u003c/p\u003e\u003cp\u003eN8: \"Especially with nasogastric tube insertion\u0026mdash;since starting home visits, my technique has become more skilled and steady.\"\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eEnhanced Hospital Reputation and Patient Trust\u003c/h2\u003e\u003cp\u003eThe \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" program brought together core clinical and specialist nurses through an online platform, allowing them to fully utilize their professional expertise to deliver high-quality nursing care to home-based patients. This effort enhanced the hospital's reputation and patient satisfaction.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eN1: \"I feel that overall patient satisfaction and positive feedback are very high.\"\u003c/h2\u003e\u003cp\u003eN4: \"A patient who had been discharged from another hospital learned about our service and contacted me. After one visit, they trusted me completely and entrusted me with wound dressing and suture removal.\"\u003c/p\u003e\u003cp\u003eN12: \"When we visit patients' homes, they and their families are very welcoming\u0026mdash;they even invited us to meals and showed great trust in us.\"\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eTheme 2:Practical Barriers\u003c/h2\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003eSystemic Barriers\u003c/h2\u003e\u003cp\u003eSystemic barriers stem from inadequate institutional design, resource allocation, and policy support, primarily manifested as insufficient logistical support, service coverage and cost limitations, and lack of promotion.\u003c/p\u003e\u003cp\u003eIn terms of logistical support, some interviewees mentioned difficulties in transportation, such as inconvenient travel and challenges returning after visits, especially from remote areas where finding return transportation was difficult, increasing personal financial and time burdens. Difficulties in human resource allocation within departments also arose, as home visits often conflicted with ward duties, requiring frequent shift changes and increasing departmental management pressure. Additionally, only one shared medical supply kit was available hospital-wide, making it inconvenient to access.\u003c/p\u003e\u003cp\u003eN4: \u0026ldquo;The company car is set to depart from the hospital, but nurses on rest days have to come from home to the hospital to take the car. They can\u0026rsquo;t set off directly from home, which is very time-consuming. For very remote areas, after taking a car there, it\u0026rsquo;s very hard to find a ride back. For example, last time I went to Jinyun Mountain, there was no transportation back.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN5: \u0026ldquo;It\u0026rsquo;s hard to get a taxi in remote areas, so I have to drive myself, which increases my expenses. Sometimes I might be called in on my day off\u0026mdash;I feel this affects my personal life.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN7: \u0026ldquo;Personally, I find it very troublesome to get the service kit from the hospital every time. Nurses in our department who do home visits use a kit prepared by the department\u0026mdash;it\u0026rsquo;s much more convenient.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN8: \u0026ldquo;There are very few colleagues on duty in our ward. If I go out for a home visit, the ward will be short-staffed.\u0026rdquo;\u003c/p\u003e\u003cp\u003eRegarding service coverage and cost limitations, the \u0026ldquo;Internet\u0026thinsp;+\u0026thinsp;Nursing Services\u0026rdquo; faces challenges due to geographical restrictions. These limitations prevent some patients in need from accessing services, highlighting a gap between service coverage and user demand.\u003c/p\u003e\u003cp\u003eN8: \u0026ldquo;When he placed the order, it seemed his home was too far away\u0026mdash;outside our service radius.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN10: \u0026ldquo;Currently, our hospital\u0026rsquo;s service radius is only about 10 kilometers. Some patients have these needs but live outside this range, so they can\u0026rsquo;t place orders.\u0026rdquo;\u003c/p\u003e\u003cp\u003eSome interviewees also mentioned the high cost of \u0026ldquo;Internet\u0026thinsp;+\u0026thinsp;Nursing Services,\u0026rdquo; which places a heavy financial burden on patients. Currently, home-visit services are entirely out-of-pocket, contrasting sharply with the reimbursement policies for outpatient services. This leads some patients to forgo the service due to cost concerns. Many eligible patients, especially those requiring long-term care such as stoma patients, choose to visit the hospital in person due to price factors. The high cost has become a major barrier to the wider adoption of Internet-based nursing services, underscoring an urgent need to explore integration with health insurance systems to alleviate financial pressure on patients and improve service accessibility and acceptance.\u003c/p\u003e\u003cp\u003eN8: \u0026ldquo;Many of our stoma patients don\u0026rsquo;t place orders online\u0026mdash;they come directly to our ward. They feel it\u0026rsquo;s more expensive to order online.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN9: \u0026ldquo;I wish the price could be a bit lower. Once we had a patient who was very suitable for home service, but after we mentioned the price, he hesitated and didn\u0026rsquo;t choose it. Every time, he brought the patient to the hospital.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN10: \u0026ldquo;Internet\u0026thinsp;+\u0026thinsp;Nursing Services may become the norm in the future, but the cost is a bit high for patients, especially with high demand. Including material fees, it might be slightly expensive.\u0026rdquo;\u003c/p\u003e\u003cp\u003eIn terms of promotion, there is a significant unmet demand for \u0026ldquo;Internet\u0026thinsp;+\u0026thinsp;Nursing Services.\u0026rdquo; Current promotion efforts are clearly insufficient, with most patients learning about the service through word of mouth or by chance, reflecting a lack of systematic outreach. Many patients with nursing needs only become aware of the home service after extensive inquiries, indicating limited dissemination and penetration of service information. This is especially true for specialized nursing items such as indwelling gastric or urinary catheters, which have low public awareness, creating an information gap between potential demand and actual service supply. This low level of awareness severely limits the popularization and effectiveness of \u0026ldquo;Internet\u0026thinsp;+\u0026thinsp;Nursing Services.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eN3: \u0026ldquo;Many patients only learned that our hospital offers Internet\u0026thinsp;+\u0026thinsp;Nursing Services after asking around repeatedly.\u0026rdquo;\u003c/h2\u003e\u003cp\u003eN8: \u0026ldquo;They don\u0026rsquo;t know that our hospital can provide home services like indwelling gastric or urinary catheterization. I think promotion efforts need significant improvement\u0026mdash;many people are simply unaware.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN12: \u0026ldquo;One patient I visited last time said he hadn\u0026rsquo;t known our hospital offered home services\u0026mdash;he only found out through another patient.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eOperational Barriers\u003c/h2\u003e\u003cp\u003eOperational barriers involve procedural shortcomings and safety risks during service delivery, mainly reflected in significant safety concerns and flaws in process design.\u003c/p\u003e\u003cp\u003eRegarding safety risks, some interviewees reported that safety was a major concern. First, nurses enter unfamiliar environments alone to provide services without prior knowledge of the patient\u0026rsquo;s family background or household composition, posing potential safety risks. Second, they may encounter service recipients with harmful social habits or unstable emotions, increasing threats to their personal safety. Third, technical difficulties or unsatisfactory treatment outcomes during procedures can easily trigger anxiety among family members, potentially leading to aggressive behavior. These safety concerns highlight urgent needs for improvement in risk assessment, safety protection, and emergency response mechanisms in \u0026ldquo;Internet\u0026thinsp;+\u0026thinsp;Nursing Services.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN1: \u0026ldquo;I think safety is a very important consideration when I provide home visits alone. We enter an unfamiliar environment without knowing the specifics.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN6: \u0026ldquo;For example, once I visited a family where the patient was an elderly woman, and her husband was kind, but all their children were drug users\u0026mdash;long-haired, smoking, both men and women. It was terrifying, and I was worried about my safety.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN8: \u0026ldquo;Once, when inserting a gastric tube, the guidewire couldn\u0026rsquo;t be removed. I was very anxious, and the family was also very worried. That visit took a long time\u0026mdash;it took three attempts to successfully place the tube. I was concerned the family might become aggressive.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN10: \u0026ldquo;Another issue is not knowing the patient\u0026rsquo;s background\u0026mdash;could they have severe social habits? We have no idea about these aspects until we arrive. So, safety is a worry.\u0026rdquo;\u003c/p\u003e\u003cp\u003eIn terms of process design, \u0026ldquo;Internet\u0026thinsp;+\u0026thinsp;Nursing Services\u0026rdquo; faces multiple limitations. First, the singular qualification requirements for nurses reduce service efficiency\u0026mdash;multiple care needs from the same patient often require separate visits by differently qualified nurses, leading to wasted human resources and increased service costs. Second, the lack of standardized management for nursing supplies means different nurses bring different brands and models of materials, affecting patient experience and treatment continuity. Third, the current 24-hour advance booking mechanism struggles to meet urgent care needs, such as blocked urinary catheters, causing unnecessary patient suffering. These procedural limitations highlight the need for optimization in flexibility, response speed, and resource integration within the current service model.\u003c/p\u003e\u003cp\u003eN10: \u0026ldquo;For example, if a patient is used to a certain type of gastric or urinary catheter and finds it works well, but the nursing department doesn\u0026rsquo;t necessarily assign the same nurse every time, the materials brought may differ, and the patient finds it inconvenient.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN9: \u0026ldquo;I encountered a situation where the same patient ordered both urinary and gastric tube services. On the platform, I only have qualifications for catheterization, while another nurse is qualified for gastric tube insertion. So, two nurses from different departments were sent\u0026mdash;one for the gastric tube, one for the urinary catheter. It would be better if one nurse could have multiple qualifications and be sent alone. Sending two people for two procedures is a waste of manpower and time.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN7: \u0026ldquo;In fact, every nurse is capable of performing these procedures. If a patient needs both a urinary catheter and a gastric tube, they could choose the same nurse for multiple services, which could also save costs.\u0026rdquo;\u003c/p\u003e\u003cp\u003eN1: \u0026ldquo;From the patient\u0026rsquo;s perspective, the 24-hour advance booking requirement is problematic. For example, if a urinary catheter is suddenly blocked and the patient\u0026rsquo;s bladder has been distended for hours, making them wait 24 hours for a home visit is a painful process. It also poses safety risks. I think the 24-hour requirement could be reduced to 8 hours, or there could be an expedited option based on the patient\u0026rsquo;s condition.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eTheme 3:Support Needs\u003c/h2\u003e\u003cdiv id=\"Sec21\" class=\"Section3\"\u003e\u003ch2\u003eTeam Collaboration\u003c/h2\u003e\u003cp\u003eSome interviewees emphasized the need for collaborative support from head nurses, colleagues, and specialized physicians when participating in \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services.\" Optimizing human resource allocation through flexible scheduling and strengthening multidisciplinary team building were highlighted as essential to addressing cross-disciplinary challenges.\u003c/p\u003e\u003cp\u003eN1: \"I always try to go with a resident trainee. Having two people for home visits ensures safety and also helps the trainee learn about the service.\"\u003c/p\u003e\u003cp\u003eN9: \"We need support from doctors. Sometimes we bring a doctor along to examine a patient\u0026rsquo;s wound.\"\u003c/p\u003e\u003cp\u003eN12: \"When I need to go out during work hours, I have to ask the head nurse to adjust my schedule and arrange cover. Once, I encountered a patient with prostate hyperplasia during catheterization. It was difficult and I didn\u0026rsquo;t succeed. I communicated with a urology doctor, who recommended that the patient see a specialist at the hospital.\"\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003ePolicy Support\u003c/h2\u003e\u003cp\u003ePolicy support needs for \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" primarily focus on cost reimbursement mechanisms. Currently, home-based nursing services are entirely self-paid, creating a significant disparity with outpatient services that are eligible for insurance reimbursement.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eN9: \"It would be great if our service fees could be covered by health insurance.\"\u003c/h2\u003e\u003cp\u003eN11: \"For example, if it could be linked to medical insurance so patients don\u0026rsquo;t have to pay out-of-pocket, the service might be more readily accepted. Currently, outpatient services are reimbursable.\"\u003c/p\u003e\u003cp\u003eN12: \"Right now, home visits are completely self-paid, while outpatient care is partially reimbursed. I wonder if it\u0026rsquo;s possible in the future to link online orders with insurance to reduce the financial burden on patients.\"\u003c/p\u003e\u003cp\u003eN8: \"Support from the national government is needed. Including these costs in health insurance could alleviate financial pressure on the public.\"\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eTheme 4:Directions for Improvement\u003c/h2\u003e\u003cp\u003eSeveral interviewees suggested that optimizing service processes, strengthening promotion, expanding services, and enhancing safety measures are key areas for improvement in \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services.\" Systematic optimization would improve efficiency, safety, and accessibility to meet diverse patient needs.\u003c/p\u003e\u003cp\u003eN1: \"We could focus on promoting the service in welfare institutions and nursing homes\u0026mdash;they have greater demand for home visits.\"\u003c/p\u003e\u003cp\u003eN3: \"Regular seminars should be held to share experiences and learn better ways to handle different situations. Better communication among staff is needed.\"\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eN4: \"The company car arrangement should be optimized to allow nurses to start from home.\"\u003c/h2\u003e\u003cp\u003eN6: \"We could coordinate within the department to have a intern accompany and assist during visits.\"\u003c/p\u003e\u003cp\u003eN7: \"Personally, I find fetching the kit troublesome, so I prepared one in our department. The home visit procedure could be more detailed, and annual training should be organized. When suture removal is needed, we should bring a doctor.\"\u003c/p\u003e\u003cp\u003eN8: \"If the same patient orders both urinary and gastric tube services, only one nurse should be assigned. The cost for a home visit is quite high, and some patients cannot afford it. Insurance coverage would definitely reduce the cost burden.\"\u003c/p\u003e\u003cp\u003eN10: \"We should consider expanding the service range. Families with concerning social habits or history of drug use should be flagged in the system. The nursing department should clearly inform nurses and emphasize safety precautions. Bringing one or two interns, preferably male students, would be helpful.\"\u003c/p\u003e\u003cp\u003eN12: \"I feel a bit nervous going alone, so I always take an intern from the department. Whenever possible, I bring a male student with me.\"\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003eThe Critical Role of \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" in Improving Healthcare Accessibility\u003c/h2\u003e\u003cp\u003eBy enabling online appointments and home visits, \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" breaks the constraints of traditional medical care models, allowing homebound patients to receive professional nursing care at home. This approach benefits not only patients and their families but also nurses and hospitals. It offers significant convenience to service recipients, helps establish positive nurse-patient relationships, improves hospital efficiency, facilitates convenient patient care, and gains recognition from patients [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. It also saves time and human costs for patients and families [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], while helping nurses achieve self-fulfillment and a sense of accomplishment [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This study demonstrates that the service greatly facilitates patients with limited mobility, reduces transportation and human resource costs for families, and alleviates the overall burden associated with hospital visits. At the same time, nurses gain professional growth and satisfaction through their participation, and hospitals enhance their reputation while increasing patient trust and satisfaction.\u003c/p\u003e\u003cp\u003eThe service meets diverse nursing needs, covering areas such as catheterization, wound dressing, stoma care, and rehabilitation training, thereby supporting patients from acute phases through recovery. By shifting certain nursing services from the hospital to the home, it reduces pressure on hospital bed turnover, optimizes the allocation of medical resources, and shortens hospital stays to some extent.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eOptimizing Service Processes to Improve Efficiency\u003c/h2\u003e\u003cp\u003e\"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" requires that nurses possess appropriate qualifications and pass training assessments before providing continuous care to residents[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. As the managing body, the nursing department should regularly organize skill training and encourage nurses to obtain qualifications in multiple procedures, such as catheterization, venipuncture, and nasogastric tube care. This can reduce the need for dispatching multiple nurses for a single patient with complex needs, thereby improving service efficiency and reducing labor costs. Chen Yanling et al.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] highlighted the importance of establishing multidisciplinary collaboration mechanisms for professional guidance. Medical institutions should form multidisciplinary support teams that include physicians, enabling online nurses to obtain real-time guidance via voice or video calls. Building multidisciplinary medical teams tailored to the features of \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" allows both online consultation and offline home visits, addressing diverse patient needs[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], enhancing the professionalism and safety of nursing services, and reducing the need for follow-up visits or transfers due to operational challenges.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eThorough Safety Risk Assessment to Protect Nurses\u003c/h2\u003e\u003cp\u003eNurses from hospitals of different levels consistently report safety concerns as a major factor hindering the development of \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In this study, nurses\u0026rsquo; safety concerns align with findings from Li Yuan et al.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and Zhang Jiayan et al.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The personal safety of online nurses during home visits is a significant risk, making it essential to understand potential safety incidents and their handling during service delivery. Risk prevention should be prioritized over post-incident response, and preventive awareness must be emphasized to mitigate risks[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In addition to implementing strict access assessments for service items, it is crucial to evaluate the service recipient and home environment in advance, ideally after the patient books the appointment but before the visit. International practices, such as using a home environment assessment checklist[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], can be adopted for systematic evaluation. Nurses should also be provided with necessary protective measures, such as GPS alert devices and workflow recorders, to minimize safety risks[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStrengthening Promotion to Increase Public Awareness and Benefit More Recipients\u003c/h3\u003e\n\u003cp\u003eAlthough there is substantial demand for \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services,\" public awareness remains limited. Many are either unaware of the service or do not know how to access it, which restricts its broader adoption. Survey results from Zhao Ying et al.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] show that patients lack understanding of the operational model, documentation, and information platforms related to the service. Older adults, in particular, have limited access to information and primarily learn through traditional media such as newspapers and television[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Therefore, multipronged promotional strategies are recommended:\u003c/p\u003e\u003cp\u003e①Online channels: Introduce the service through hospital websites, official WeChat accounts, and short-video platforms (e.g., Douyin, Kuaishou) with service descriptions, user guides, and success stories.\u003c/p\u003e\u003cp\u003e②Offline channels: Distribute brochures, display posters in nurse stations and outpatient halls, and hold patient conferences within hospital departments. Externally, organize health talks or free clinics in communities and nursing homes to promote the service face-to-face among key populations.\u003c/p\u003e\u003cp\u003e③Media collaboration: Partner with local TV stations, radio channels, and magazines to produce feature programs and public service announcements, expanding social impact.\u003c/p\u003e\u003cdiv id=\"Sec31\" class=\"Section2\"\u003e\u003ch2\u003eSeeking Government Reimbursement Policy Support to Ensure Sustainable Development\u003c/h2\u003e\u003cp\u003eInterviews revealed that although \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" offers many benefits, some patients are deterred by the cost. Zhao Ying et al.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] suggest that government agencies and hospitals set reasonable prices based on the complexity and duration of services. While incentivizing nurses from different levels of hospitals to actively participate, cooperative payment methods such as health insurance could be introduced to reduce patient costs, truly fulfilling the government\u0026rsquo;s goal of accessible services. Yin Shiyu et al.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and Wang Chong et al.[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] recommend that medical insurance authorities include certain nursing services in the reimbursement system and support online payment to reduce user burden and improve convenience. Li Xia [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and Gao Yumeng[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] propose integrating \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" into long-term care insurance with proportional reimbursement. Internationally, Australia\u0026rsquo;s social health insurance covers part of home-visit costs, while countries such as Japan, the United States, and the United Kingdom allow long-term care insurance to pay for home nursing services[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In China, Ningbo, Zhejiang Province, included three home medical nursing items\u0026mdash;peripherally inserted central catheter maintenance, indwelling urinary catheter care, and nasogastric tube care\u0026mdash;in health insurance coverage in December 2021, with at-home payment supported[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. It is urged that provinces and cities gradually incorporate \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" fees into medical insurance or long-term care insurance reimbursement systems to alleviate financial pressure on patients and promote sustainable development of the service.\u003c/p\u003e\u003cp\u003eWe strongly recommend that other provinces and municipalities accelerate policy innovation to include \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" within public insurance schemes. Such measures will not only reduce out-of-pocket expenses for patients but also provide a stable, sustainable funding mechanism, facilitating broader adoption and system-wide implementation of digital nursing services.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights that while \"Internet\u0026thinsp;+\u0026thinsp;Nursing Services\" offer significant benefits to patients, nurses, and hospitals, its sustainability is challenged by operational barriers, safety risks, limited awareness, and lack of reimbursement mechanisms. To enhance service quality and nurse satisfaction, we recommend optimizing workflows, strengthening safety protocols, expanding targeted promotion, and advancing insurance integration. Future efforts should develop patient-centered, nurse-safe home care models through multi-stakeholder collaboration. Limitations include single-center sampling; further multi-center and quantitative studies are needed to support policy-making and scalability.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eINS \u0026nbsp;Internet+Nursing Service\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our sincere gratitude to all nurses who participated in the \u0026quot;Internet + Nursing Services\u0026quot; initiative and shared their valuable experiences and insights gained throughout their engagement in this program.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe declare that all authors meet the criteria for authorship and have approved the final article, and that all those entitled to authorship are listed as authors.Study design: \u0026nbsp;Zhuoyuanyuan Chen; Development of interview guide: \u0026nbsp;Zhuoyuanyuan Chen, \u0026nbsp; Yunling Long; Data collection and analysis: Zhuoyuanyuan Chen, Yunling Long, \u0026nbsp; Yuling Xie; Manuscript writing: Zhuoyuanyuan Chen, Yunling Long; Review and editing: Zhuoyuanyuan Chen, Yuling Xie.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChongqing Municipal Education Commission\u0026apos;s 14th Five-Year Key Discipline Support Project\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Beibei Hospital of Chongqing Medical University in accordance with the principles of the Declaration of Helsinki (Approval No.: 2025-Science (Ethics)-016). Written informed consent, including permission for audio recording, was obtained from each participant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWang W, Liu L. Advances in the application of human-machine collaboratio-n in healthcare: insights from China. Front Public Health. 2025;13:1507142. doi:10.3389/fpubh.2025.1507142.\u003c/li\u003e\n \u003cli\u003eGenovese G, Rizzo CE, Nirta A, et al. Mapping Healthcare Needs: A Systematic Review of Population Stratification Tools. 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Experiences of primary hospital nurses conducting \u0026apos;Internet+Nursing Services\u0026apos; under the medical consortium model. J Nurs Sci. 2024;39(3):100\u0026ndash;102,107.\u003c/li\u003e\n \u003cli\u003eLi X, Wang YP, Bai Y, et al. A qualitative study on nurses\u0026rsquo; practical exp-eriences in \u0026apos;Internet+Nursing Services\u0026apos;. Chin Nurs Manag. 2020;20(11):1662\u0026ndash;1666.\u003c/li\u003e\n \u003cli\u003eFang TL, Liu LH, Chen J, et al. Nurses\u0026rsquo; service experience in the initial stage of \u0026apos;Internet+Nursing Services\u0026apos;. Chin Nurs Manag. 2022;22(8):1253\u0026ndash;1257.\u003c/li\u003e\n \u003cli\u003eWang LT, Tang LJ, Yue LC, et al. A study on nurses\u0026rsquo; working experience in Internet-based home nursing services. Chin J Nurs. 2020;55(7):1067\u0026ndash;1071.\u003c/li\u003e\n \u003cli\u003eChen YL, Yang QH, Yu HY, et al. 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Chin J Hosp Adm. 2023;39(7):546\u0026ndash;549.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Internet + Nursing Services, Nurse’s Experience, Qualitative Research, Thematic Analysis, Home Care Services, China","lastPublishedDoi":"10.21203/rs.3.rs-7593331/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7593331/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e The \"Internet\u0026thinsp;+\u0026thinsp;Nursing Service\" (INS) is an innovative model developed in China to extend professional nursing care to home settings, particularly for elderly and chronically ill patients. Despite its potential to enhance healthcare accessibility, little is known about the experiences of clinical nurses who deliver these services, especially in Western China.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e This study aimed to explore the experiences of clinical nurses participating in INS in a public tertiary hospital in Western China.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e A qualitative descriptive study was conducted using semi-structured interviews with 12 clinical nurses who had completed at least five INS assignments. Data were analyzed using thematic analysis.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e Four main themes emerged: (1) Service value (professional growth, patient convenience, hospital reputation); (2) Practical barriers (logistical support, safety risks, procedural limitations); (3) Support needs (team collaboration, policy support); (4) Directions for improvement (process optimization, safety assurance, publicity expansion).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e INS plays a critical role in enhancing continuity of care, but its sustainability requires systematic improvements in safety mechanisms, reimbursement policies, and publicity strategies. Support from hospitals, policymakers, and society is essential to optimize this service model.\u003c/p\u003e\u003cp\u003eClinical trial registration Not applicable.\u003c/p\u003e","manuscriptTitle":"Clinical nurses’ experiences of providing ‘Internet+Nursing Services’ in public hospitals: a qualitative study in Western China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-30 06:24:52","doi":"10.21203/rs.3.rs-7593331/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-17T09:49:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-05T00:36:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-03T02:26:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206533033224803261712304158583410582274","date":"2025-10-30T05:17:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164497428471981103018701314207161780618","date":"2025-10-24T12:49:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-18T23:38:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107727731490414644747007541480982649441","date":"2025-10-18T21:11:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"179114608301576267869198269421447437758","date":"2025-10-16T14:40:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-16T14:24:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-17T14:11:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-15T11:02:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-15T11:02:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-09-11T15:12:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"164166d2-6bc8-4278-bd65-eab35e807433","owner":[],"postedDate":"October 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-26T09:08:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-30 06:24:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7593331","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7593331","identity":"rs-7593331","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}