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The relationship between technology and changing professional ...


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The relationship between technology and changing professional ...

  1. 1. The relationship between technology and changing professional roles in health care : a case-study in teledermatology Dr. Stephen Timmons, School of Nursing, University of Nottingham Mrs. Sandra Lawton, Consultant Nurse, Dermatology, Queen's Medical Centre, Nottingham
  2. 2. Background • Huge unmet need for dermatological care • Increasing referrals and waiting lists/times • Too few dermatologists • Difficult physical access to hospital • Patients seen by the most appropriate member of the dermatology team • An equitable service across the district
  3. 3. GeographyGeography Nurse ledNurse led communitycommunity clinics inclinics in primary careprimary care supported bysupported by teledermatologyteledermatology.
  4. 4. Store and Forward Telemedicine Mail Server Telemarque Server Unit Training Data Base NHS Net Remote GPwSI QMC Dermatology Unit Unit Live Remote PCT Clinics
  5. 5. TeledermatologyTeledermatology Store & ForwardStore & Forward • Digital CameraDigital Camera • Lap TopLap Top • EmailEmail
  6. 6. MethodsMethods Case Study DesignCase Study Design • Embedded single case designEmbedded single case design • Single case – community clinicsSingle case – community clinics • Subunits- all those involved inSubunits- all those involved in patient journey (patient journey (GP, Patient,Nurse,GP, Patient,Nurse, Dermatologist and others)Dermatologist and others)
  7. 7. Patient JourneyPatient Journey M a n a g e d b y D e r m a t o l o g y N u r s e S h a r e d c a r e w i t h P r i m a r y C a r e T e a m S u r g e r y C o n s u l t a t i o n L i g h t t h e r a p y M a n a g e m e n t P l a n T e l e d e r m a t o l o g y t o C o n s u l t a n t D e r m a t o l o g i s t D a y T r e a t m e n t P a t c h T e s t A d m i s s i o n S e c o n d a r y C a r e S e r v i c e s P C T C l i n i c N u r s e L e d S e r v i c e G P R e f e r r a l t o l o c a l P C T C l i n i c N u r s e L e d S e r v i c e
  8. 8. SampleSample • Purposively selectedPurposively selected • 2 patient journeys:2 patient journeys: GP, Patient,GP, Patient, Nurse, Dermatologist and othersNurse, Dermatologist and others
  9. 9. Data CollectionData Collection • Semi-structured interviewsSemi-structured interviews • Observation of the nurse / patientObservation of the nurse / patient consultationconsultation • Data obtained from clinical recordsData obtained from clinical records and databases.and databases.
  10. 10. Data AnalysisData Analysis • The analysis and interpretation of the dataThe analysis and interpretation of the data was performed manually.was performed manually. • Based on an ethnographic approach andBased on an ethnographic approach and influenced by the principles of groundedinfluenced by the principles of grounded theorytheory • Description of the case (How and Why)Description of the case (How and Why) • Comparative analysis of the data sets :Comparative analysis of the data sets : ( interviews,observations and records)( interviews,observations and records) • Analysis of the emerging themesAnalysis of the emerging themes
  11. 11. Results/Discussion
  12. 12. The unimportance of technology “No it’s not the main focus, I mean I don’t know why everybody goes on about it being the main focus, because it is telederm it’s all electronic. It’s actually supporting the nurses who are acting in their own right for their own clinics. That’s what it’s about. It’s not about putting the information on and passing it on to me.” (Consultant Dermatologist)
  13. 13. Shifting boundaries : how ? • By using teledermatology, individual and organisational practices have been adjusted • Nurses collect information • But, crucially, decide when & how to refer • The nurses’ role now, effectively, includes diagnosis
  14. 14. Patients • Like the service, and are unconcerned about the profession of the person seeing them • GPs value the expertise of the nurses
  15. 15. The GPs “It’s not so much things I need a huge diagnosis on but ones I feel the patient will benefit from a longer time in terms of explanation, or if they have been having conventional treatment for a common disorder and things aren’t improving then sometimes I feel they might do better if they came to your clinic, the nurse-led clinic.” GP
  16. 16. An ‘advance’ in nursing practice • A contentious point (in nursing) • Not just working to protocols (as often happens in ‘nurse-led’ services) • Used existing skills and knowledge, and developed new ones.
  17. 17. How was it possible ? 1 Policy push 2 Skills of the nurses 3 Agreement & support from the consultant & the GPs 4 The technology
  18. 18. A bit of theory • ANT ? • Social construction of technology