Objective: To consolidate existing evidence on experiences and perspectives of healthcare providers involved in telemedicine services in long-term residential care. Methods: A scoping review was conducted. A systematic search for articles published in 2000–2021 was performed in CINAHL, Web of Science, PubMed, EMBASE and Scopus; further, relevant journals and grey literature websites were hand searched. Key search terms included ‘telemedicine’, ‘telehealth’ and ‘nursing homes’. Results: Twenty-six articles were included. A narrative synthesis of evidence was conducted. The review identified four themes: (1) Presence of multidisciplinary care, (2) perceived usefulness of telemedicine, (3) perceived ease of use and (4) expanded role of nursing home staff. The presence of multidisciplinary care providers provided a wide range of telemedicine services to residents and promoted interprofessional collaboration between acute and long-term care. Telemedicine was perceived to increase timely onsite management by remote specialists, which enabled care quality improvement. However, technical problems associated with equipment usage reduced the ease of use of telemedicine. Concerns emerged from the expanded role of nursing home staff, which could negatively affect clinical decision-making and create medico-legal risks. Conclusion and implications: Telemedicine is valuable in distance-based care, especially in the current 2019 coronavirus pandemic, for supporting continuity of care to nursing home residents. This review provided evidence from multiple healthcare providers’ perspectives. Further research can elucidate their specific roles and responsibilities in telemedicine and challenges in work processes, which will facilitate developing evidence-based competencies and improving technical infrastructure, thus contributing to personal and organisational readiness for telemedicine integration.

Objective To define clinical empathy from the perspective of healthcare workers and patients from a multicultural setting. Design Grounded theory approach using focus group discussions. Setting A health cluster in Singapore consisting of an acute hospital, a community hospital, ambulatory care teams, a medical school and a nursing school. Participants 69 participants including doctors, nurses, medical students, nursing students, patients and allied health workers. Main outcome measures A robust definition of clinical empathy. Results The construct of clinical empathy is consistent across doctors, nurses, students, allied health and students. Medical empathy consists of an inner sense of empathy (imaginative, affective and cognitive), empathy behaviour (genuine concern and empathic communication) and a sense of connection (trust and rapport). This construct of clinical empathy is similar to definitions by neuroscientists but challenges a common definition of clinical empathy as a cognitive process with emotional detachment. Conclusions This paper has defined clinical empathy as ‘a sense of connection between the healthcare worker and the patient as a result of perspective taking arising from imaginative, affective and cognitive processes, which are expressed through behaviours and good communication skills that convey genuine concern’. A clear and multidimensional definition of clinical empathy will improve future education and research efforts in the application and impact of clinical empathy.

Background: Widespread and sustained adoption of telemedicine in long‐term residential care is emerging. Nursing home (NH) nurses play a key role in collaborating with remote physicians to manage residents' medical conditions through videoconferencing. Therefore, understanding of interprofessional collaboration and effective communication between nurses and physicians is critical to ensure quality of care and safety during teleconsultations.Aims: To explore NH nurses' and physicians' experiences of interprofessional collaboration and communication during teleconsultations.Methods: A qualitative descriptive design was adopted. Purposive sampling was conducted to recruit 22 physicians and nurses involved in NH teleconsultations. Semi‐structured online interviews were conducted, and data were thematically analyzed.Results: Three themes were identified: (1) Manner of communication in telemedicine, (2) sociocultural influences in collaborative practice, and (3) role expectations in telemedicine. Both nurses and physicians recognized the importance of building and maintaining trust as physicians heavily depended on nurses for provision of objective information for clinical decision‐making. However, practice differences were observed between nurses and physicians during teleconsultations. Sociocultural influences such as power relations and language barriers also affected the nurse–physician relationship and interpersonal communication. Additionally, different performance expectations were identified between nurses and physicians.Conclusion: Interprofessional collaboration in teleconsultations is challenging because of lack of in‐person assessment and dependence on nurses for clinical information. In addition, expectations and communication styles differ among healthcare professionals. This study called for interprofessional telemedicine training with incorporation of shared mental models to improve role clarity and communication. Given the international‐dominated healthcare workforce in long‐term care, the development of cultural competency could also be considered in telemedicine training to enhance nurse–physician collaborative practice.Clinical Relevance: Telemedicine is increasingly adopted in long‐term care settings, where multidisciplinary healthcare professionals from different health institutions are involved in resident care. Interprofessional collaboration should be incorporated into telehealth education for enhanced clinical practice in this care delivery model.

There are few studies concerning the differences in quality-of-life (QOL) between palliative care patients with and without dysphagia to date. We aimed to compare the QOL and symptoms in palliative patients with and without dysphagia using Swallowing Quality of Life (SWAL-QOL). Eighty-one palliative patients with and without dysphagia underwent the SWAL-QOL questionnaire. A series of Mann Whitney U tests were performed between non-dysphagic and dysphagic groups for the total SWAL-QOL score and the 11 SWAL-QOL domains. Dysphagia significantly impacted patients’ QOL in the dysphagic group (mean, 69.5; SD 21.9) than non-dysphagic group (mean, 83.2; SD 14.8) (P = 0.006). Significant differences were observed between both groups for the domains of burden, eating desire, eating duration, symptoms, food selection, communication and mental health. The results also showed that the dysphagic group had lower symptom score across all symptoms, suggesting higher symptom burdens. This study is the first to examine QOL and swallow symptoms in palliative care patients with and without dysphagia. Dysphagia causes significantly worse QOL in palliative care patients. Screening for dysphagia and managing its impact on symptoms and QOL domains is important in palliative care.

Dysphagia is common in palliative patients and worsens quality of life. Nurses are the main provider of dysphagia care. An audit showed poor compliance with dysphagia measures among nurses, but little is known about what the barriers are. We sought to evaluate barriers to dysphagia care among hospice nurses. This was a stepwise, mixed-method study. Baseline knowledge and attitudes were assessed, and a lecture was crafted based on the assessment. The knowledge and attitudes were then reassessed to investigate for any change. A focus group and an open-ended questionnaire were then used to assess for other barriers and for the effectiveness of training. Knowledge scores were low at baseline, and training improved the scores. Nurses cited the lack of time and lack of families’ involvement as barriers to dysphagia care. While nurses believed that preventing aspiration is important, they also felt that most patients would refuse a modified diet and that respecting their wishes is important. Most nurses felt that the training increased their ability to care for patients with dysphagia. Our study demonstrated that knowledge deficit was an important barrier in dysphagia care for nurses, and this can be improved with a short training. Even though nurses rightly believed that patients’ preferences are important, they struggled with trying to balance these preferences with preventing aspiration. Supporting them in making these decisions, having more time for feeding patients, and involving family members may be important to reduce barriers to care for patients with dysphagia.

Objective In Singapore, more elderly are living in nursing homes (NHs), with a resultant increase in deaths occurring in NHs. However, palliative care training is limited in Singapore’s core nursing curriculum, and many NHs rely on foreign-trained staff who may not have previous palliative care training. Our study aimed to evaluate whether a needs-based course can improve the palliative care knowledge and attitudes of NH nurses in Singapore. Methods Twenty-five nurses participated in the study. The intervention was an 8-week palliative care course developed based on needs assessment and led by a multidisciplinary faculty. A 50-item knowledge test was administered at baseline and 0 day and 3 and 6 months postcourse. Semistructured interviews were conducted at 3 months to assess for changes in attitudes and nursing practices. Results The mean knowledge score increased significantly from 31.4 (±4.4) precourse to 35.1 (±5.1) at 3 months. Knowledge scores in end-of-life care increased up to 6 months, and scores for pain and symptom management increased significantly at 3 months. Participants reported a positive change with improved communication skills and increased compassion. There was a lack of opportunities to apply some new knowledge and skills due to regulations and perceived residents’ preferences to engage more local senior staff. Conclusion The multidisciplinary needs-based palliative care course using various teaching modalities with follow-up knowledge tests helped to increase knowledge and improve communication skills and attitudes of NH nurses towards palliative care. The increase in knowledge and positive change in attitudes was noted to be sustained for at least 3 months postcourse.