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An Integrative Review for Nurs 6183 Systems and Care Models Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy/Doctor of Nursing Practice in the Graduate School of the Texas Woman’s University


In this integrative analysis, we examine the many facets of telehealth nursing care models and their effects on patients, healthcare systems, and nursing. The introduction provides context for the review by focusing on the revolutionary consequences of telehealth on modern healthcare and the changing function of nurses within this framework. The backdrop, which uses the PICO(T) framework, provides context for the topic by outlining its significance and possible importance to telehealth nursing care models’ potential benefits and problems. The methodology section describes the search strategy, the criteria for which articles were included or excluded, and the steps taken to extract and evaluate the data. From better patient access and chronic disease management to technological hurdles and legal restrictions, we consolidate it all in the summary of findings. The importance of stakeholders addressing its intricacies and refining its models to realize telehealth nursing’s promise to alter healthcare delivery is emphasized in the final section. More research and strategic implementation are required to realize the potential of telehealth nursing fully, and these implications for nursing theory, education, legislation, and practice are examined.

Integrative Review of Care Models in Telehealth Nursing

The importance of telehealth nursing care models has emerged as a critical force in redefining patient care in an era marked by rapid technological breakthroughs and the growing need for accessible healthcare. In the review, everyone from doctors, nurses, government officials, and patients’ families are considered stakeholders in the healthcare system. This systematic review aims to examine the various telehealth nursing care models and their effects on patients, doctors, and the community at large. In addition to underlining the importance of these models in bettering healthcare delivery, it seeks to provide a comprehensive review of the current state of knowledge by identifying gaps and unexplored areas.

Background and Significance

Nursing care models that use telemedicine represent a novel approach to providing medical treatment but also present new problems and opportunities. According to Groom et al. (2021), it’s possible that patients, especially those in underserved or rural places, will have easier access to care and fewer impediments to receiving it due to the elimination of physical distance. However, the effects of these models on clinical outcomes, quality of life, and patient experience have yet to be thoroughly investigated. As Groom et al. (2021) supposed, healthcare personnel, particularly nurses, must adjust to the changing nature of their profession as new technologies and methods of delivering care become the norm. The primary objective, significance, intervention, and outcome (PICO(T)) question (POINT) driving this review is, therefore, “What are the current care models in telehealth nursing, and what are the implications for patient outcomes and nursing practice?”

Andrews et al. (2020) argue that in the PICO(T) framework on telehealth nursing, the patients who use remote healthcare access are the population of interest, and interventions include new forms of remote nursing care. By this, care models, in-person care, and telehealth deployment strategies can all be compared and contrasted. Pool et al. (2022) depict that remote monitoring, teletriage, teleconsultation, and virtual nursing care teams are all examples of telehealth nursing care models that are still being researched and developed. Therefore, patient outcomes and nurse responsibilities connected with the various care models implemented in telehealth settings are operationally defined in the integrative review.

This integrative review is essential because it may shed light on previously unexplored aspects of telehealth nursing and its effects on patients, their families, and the larger community. The benefits of telehealth go well beyond its convenience for patients; it also addresses important issues, including better care for those with chronic conditions, lower healthcare costs, and the chance to lessen their suffering and increase their quality of life. As Younas and Quennell (2019) depict, if healthcare professionals and policymakers want to optimize patient care in the future, they must have a firm grasp on state-of-the-art telehealth nursing care models now. Therefore, this review aims to consolidate relevant findings, highlight knowledge gaps, and stress the impact virtual nursing care models have on the current healthcare system.


Sample and Inclusion/Exclusion Criteria

This integrative review used a sample of papers selected through a peer-review process and adhered to strict inclusion and exclusion criteria. Care models in telehealth nursing and their applications, outcomes, and implications for patient care met the inclusion requirements. Only studies published between 2015 and 2023 were evaluated to ensure applicability to current telehealth procedures. Because of the scarcity of translation services, all studies had to be published in English. Research models for remote nursing care that were not explicitly addressed, studies with insufficient data or methods descriptions, and research conducted on populations not relevant to nursing practice were disqualified.

Literature Search

Electronic databases such as PubMed, CINAHL, and Scopus were searched systematically for pertinent articles. The search technique utilized the keywords and search terms “telehealth nursing,” “care models,” “nursing practice,” and “telemedicine.” These phrases were effectively combined using Boolean operators (AND, OR). As depicted by Wu et al. (2022), care models in telehealth nursing were the focus of this search approach and papers that met the required time period and language criteria were identified.

Search Outcome

The results from the first search were 442 articles from the chosen databases. After evaluating the titles and abstracts, 16 papers met the criteria for further review. After that, full-text reviews were performed, and eight pieces were ultimately included in the synthesis. Figure 1 (see Appendix) is a PRISMA diagram depicting the search and selection procedure.

Data Extraction and Evaluation

Data extraction and analysis followed a strict protocol, with relevant material being culled from each article. The study’s aims, methods, sample characteristics, telehealth service models investigated, outcomes evaluated, and limitations were all considered. As depicted by Toffoletto and Tello (2020), methodological quality and rigor were assessed for each paper, and the study design (e.g., quantitative, qualitative, mixed methods) was also recorded.

Data Analysis

A thematic synthesis method was used for data analysis. Important telehealth nursing care model topics were gleaned from the collected research. According to Calleja et al. (2022), the accumulated knowledge in this area was then synthesized and organized according to these categories. Synthesizing findings, identifying pattern gaps, and developing trends in telehealth nursing care models required reducing, displaying, and drawing/verifying data.


Care models in telehealth nursing are complex, as shown by the review of primary research studies. Positive results like increased patient access to care, better management of chronic diseases, and higher patient satisfaction were observed in some studies. Still, others highlighted technological difficulties, licensure impediments, and opposition to change among healthcare practitioners. The data synthesis highlights the potential advantages of virtual nursing care models in increasing healthcare access and improving patient outcomes. However, it highlights the need for additional research to address the hurdles and challenges, especially those connected to incorporating technology and legal frameworks. The literature shows promise in its acknowledgment of telehealth nursing’s revolutionary potential. Still, it needs to improve in treating the topic’s practical ramifications and effective implementation tactics, particularly across various healthcare settings.


The findings of this integrative review highlight the potential and challenges of telehealth nursing care models. Telenursing will change the face of healthcare delivery, especially in rural or hard-to-reach locations. To fully realize this potential, however, it is essential to address the identified hurdles. These include technological difficulties and legal considerations. Watkins and Neubrander (2022) emphasize that the changing nature of the nurse’s involvement in telehealth, which now has clinical expertise, digital communication, and patient education, must also be considered. This review fills in some of the blanks but also shows how much more data are needed before telehealth nursing care models can be used successfully. As long as its stakeholders tackle its issues and refine its models, telehealth nursing can be a game-changer in the healthcare system.


Significant opportunity exists to further develop nursing, nursing research, and nursing practice by studying and implementing telehealth nursing care models. According to Watkins and Neubrander (2022), further studies like this can aid in creating all-encompassing theories that explain the workings and effects of telehealth nursing care models on patient outcomes and healthcare systems. The relevance of digital literacy, telecommunication skills, and patient-centered care can also be emphasized in nursing curricula, impacting nursing education. Policymakers can use future research results to develop regulatory frameworks and licensing criteria for telehealth nursing that will pave the way for its widespread adoption. Putting this knowledge into practice will allow healthcare organizations to create telehealth nursing care models that optimize patient access, satisfaction, and outcomes.


Finally, this comprehensive analysis has explored the many care models used in telehealth nursing, illuminating their potential and limitations. This work contributes to nursing knowledge by combining current research findings to draw attention to the transformative potential of telehealth nursing and the constraints that must be overcome. The study’s implications for theory, education, and legislation highlight the potential for telehealth nursing to become an integral part of the healthcare delivery system. To ensure that telehealth care models are patient-centered, technologically advanced, and legally sound, the nursing profession must adapt and embrace the digital era as telehealth develops. The potential for telehealth nursing to transform healthcare delivery and enhance patient outcomes, making medical treatment more widely available and cost-effective, is only beginning to be explored.


Andrews, E., Berghofer, K., Long, J., Prescott, A., & Caboral-Stevens, M. (2020). Satisfaction with the use of telehealth during COVID-19: An integrative review. International journal of nursing studies advances2, 100008.

Calleja, P., Wilkes, S., Spencer, M., & Woodbridge, S. (2022). Telehealth use in rural and remote health practitioner education: an integrative review. Rural and remote health22(1), 1-13.

Groom, L. L., McCarthy, M. M., Stimpfel, A. W., & Brody, A. A. (2021). Telemedicine and telehealth in nursing homes: an integrative review. Journal of the American Medical Directors Association22(9), 1784-1801.

Pool, J., Akhlaghpour, S., Fatehi, F., & Gray, L. C. (2022). Data privacy concerns and use of telehealth in the aged care context: an integrative review and research agenda. International Journal of Medical Informatics160, 104707.

Toffoletto, M. C., & Tello, J. D. A. (2020). An integrative review of telenursing in care, education, and management in Latin America and the Caribbean. Revista brasileira de enfermagem73.

Watkins, S., & Neubrander, J. (2022). Primary-care registered nurse telehealth policy implications. Journal of Telemedicine and Telecare28(3), 203-206.

Wu, K. K., Lopez, C., & Nichols, M. (2022). Virtual visits in prenatal care: an integrative review. Journal of Midwifery & Women’s Health67(1), 39-52.

Younas, A., & Quennell, S. (2019). Usefulness of nursing theory‐guided practice: An integrative review. Scandinavian journal of caring sciences33(3), 540-555.

Appendix A. Summary of Primary Sources of Evidence

Study: Citation of Evidence Approach Context Participants Key Findings Level of Evidence
Andrews et al. (2020) An evaluation matrix was involved Ten articles (53%) included were studies conducted in the United States. 18 studies evaluated Patients and healthcare providers have a high level of satisfaction with the use of telehealth during the COVID-19 pandemic. Sixteen out of 18 studies evaluated patient satisfaction, and five examined healthcare providers’ satisfaction with telehealth.
Calleja et al. (2022) Involved in an integrative review of telehealth Countries of origin were countries in North and Central America, the UK, Europe, and Africa, and Australia and India. Sample sizes in the studies ranged from 20 to more than 1,000 participants, covering a broad range of health education topics. There is a lack of solid evidence to support the usage of various telehealth applications because they are still in their infancy. Electronic databases were examined, including CINAHL, Medline, Nursing and Allied Health (Proquest), PubMed, the Johanna Briggs Institute Evidence-Based Practice (JBI EBP), and Embas.
Groom et al. (2021). For this evaluation, we combined quantitative and qualitative data using the integrative review approach developed by Whittemore and Knafl. Primary research in New Hampshire focusing on New Hampshire inhabitants was considered for inclusion. Clinicians, citizens of New Hampshire, subacute patients, and their families all took part. Telemedicine consultations with geriatricians, psychiatrists, and palliative care specialists have been supported by preliminary evidence. A search of PubMed, Web of Science, CINAHL, Embase, PsycNET, and JSTOR for articles published between 2014 and 2020 about telemedicine and telehealth in NH settings turned up 16 articles.
Pool et al. (2022) Privacy worries, telehealth applications, and senior care were all linked in an in-depth analysis of existing research. CPCPO United States senior healthcare givers The review found that privacy problems are situational and vary depending on users, telehealth systems, aged care services, and data. Scopus, Science Citation Index, and PubMed for publications published up until December 2020
Toffoletto and Tello (2020). Integrative review, for the years 2009 to 2019, scientific databases from Latin America and the Caribbean. Twelve articles were selected. Telenursing generates changes in care practices. The information and communication technology utilized in the trials was telephony oriented toward non-communicable diseases.
Watkins and Neubrander (2022). Qualitative method Primary-care Registered Nurse Telehealth Policy Implications Unites states health department Federal legislation has responded to emergent public health needs by removing barriers that have impeded the widespread adoption of telehealth modalities It received endorsement by HRSA, HHS, or the US government
Wu et al. (2022) qualitative method Research and quality improvement projects published between 2010 and 2020 The search identified 2666 articles after removing duplicates, of which 13 met all criteria. There has been positive feedback from both patients and doctors on the use of virtual visits in prenatal care. Keywords connected with telemedicine and prenatal care were used in PubMed, Scopus, CINAHL, and Google Scholar search.
Younas and Quennell (2019). An integrative review was conducted. Most studies were from Iran, the United States, and Turkey and used Orem’s self-care model. A literature search was performed within multiple databases, and 35 studies were reviewed and appraised. Twenty-six studies found that nursing theory-guided interventions improved all outcomes, and nine found that they improved at least one result. The quality rating was judged to be strong for three studies, moderate for 25, and weak for seven.

Appendix 1

inclusion of grey literature


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