Many of the participating nurses value tele-nursing as a useful tool for improving patient accessibility to health services, by facilitating access for people living in rural areas.

I think in busy consultations, [telenursing] is a way to reach more people or patients living in rural areas. (Participant 11)

The participating nurses believe that tele-nursing has a positive impact on health and can bring many benefits. These include improved adherence to treatment, continuous monitoring of health parameters, improved follow-up in chronic pathology, surgery, etc.

It would be a good idea to include it in adult programmes and as a support to improve adherence to treatment, if they really had the right resources, I think it would be a fantastic tool. (Participant 13)

Nurses consider tele-nursing to be useful for improving professional–patient communication, resolving doubts in an agile way, and accompanying people with emotional support needs.

From primary care it would be possible to carry out many interventions with telehealth, and as a paediatric nurse I consider it a fantastic resource to help parents to solve day-to-day doubts such as those related to complementary feeding or vaccinations. (Participant 49)

They also consider that patients might prefer face-to-face care.

The majority [of patients] prefer to come to the consultation in person. (Participant 54)

Participants are concerned about the lack of adequate or obsolete equipment, logistical and financial support to implement telenursing.

I believe that today, we professionals do not have the necessary resources to do our work well through tele-nursing. (Participant 17)

Nurses are aware of the importance of being well trained to be able to apply new digital systems. They also consider it useful and necessary to train patients to be able to use telenursing.

From my point of view and in agreement with my colleagues, I reiterate the lack of resources and training when it comes to carrying out quality telenursing. (Participant 12)

Aspects such as the advanced age of health service users, as well as the fact that tele-nursing may exacerbate social inequalities, are of particular concern to nurses.

…the most important handicap is that our population is mainly an ageing population that does not have the opportunity to “jump on the bandwagon” of these new technologies. (Participant 64)

The participants consider that in the implementation of health technologies it is important to consider the privacy of users, legal coverage and the protocols that guide their actions as professionals.

The main problem I find is that today, to carry out telecare, we must resort to various apps or programs from our own electronic devices, which puts the security and privacy of patients and ourselves at risk. (Participant 40)

Despite the natural barriers of training and access to resources, telenursing has the potential of transforming nursing. As this study shows, nurses are positive about its usefulness, being able to identify numerous benefits. However, they are also aware of current limitations and areas for improvement.

On the positive side, the nurses participating in this research noted that telenursing was useful for effective and motivating follow-up and improve communication with patients. These benefits have also been pointed out by other authors who indicate that telenursing is not only useful in the clinical follow-up of patients with chronic pathology but could also be effective in improving lifestyle behaviours in chronic diseases,23–25 including promoting self-efficacy and physical activity.26 Alcazar et al., points out that telenursing can be a facilitator to foster a good, closer nurse–patient relationship.27

Our participants have also indicated that this technology can be useful to reduce complications, monitor health parameters, avoid unnecessary admissions, and resolve doubts quickly. Along the same lines, other studies have concluded that telenursing helps to detect complications more quickly after surgery,28 to solve problems or questions faster,29,30 to reduce symptoms and discomfort,31 to reduce unnecessary admissions32 and even to reduce mortality.33 It is also a useful tool to educate and support young people with chronic pathology.34

As for the negative aspects or limitations pointed out by the participants, it is important to point out that these are the same ones that are often mentioned in the adoption of other technologies35 and that in many cases could be overcome with training and institutional support.36 Telenursing cannot be used with all patients and in all situations, but it may be a further role of nurses to teach the patient to use it, thus reinforcing their digital leadership. It is interesting to note that in previous studies,27 reluctance to use tele-nursing on the part of the professionals was observed. However, this is not the case with the participants in this study, who are generally enthusiastic about the idea of its future use. Nevertheless, as participants rightly pointed out, it is important to consider the barriers that patients may present. The health system needs to be sensitive to patients’ needs to avoid widening health inequalities.8,37

While this qualitative study offers valuable insights into the perspectives and experiences of nurses engaged in a MOODLE course, it is important to acknowledge some limitations that may impact the generalizability of these findings. The study was conducted with a relatively small sample of students from a specific course which may not fully capture the diversity of opinions and experiences that could exist within a broader professional group of nurses. Subjects who chose to participate in the forums may have different characteristics or experiences compared to those who declined, potentially leading to a skewed representation of opinions. Future studies will include secondary analysis about the participants (e.g., age range, urban vs. rural practice, years of experience) to better understand the contexts from which the perceptions are drawn. Finally, as with any self-reported data, there is a possibility of social desirability bias, where participants may provide responses, they perceive as socially acceptable rather than their true opinions. It is important to contextualize that the data used for the study comes from the direct participation of the 45% of the professionals enrolled in the course and the researchers had no access to the opinions and perceptions of remaining 55%, which may affect these findings.

The COVID-19 pandemic has significantly accelerated the adoption of telemedicine, transforming the way healthcare services are delivered. Several studies and reports have highlighted the impact of telemedicine on patient care delivery, patient satisfaction, and safety during the confinement period.38,39 The experiences gained during the pandemic have paved the way for a more integrated approach to healthcare, combining both in-person and virtual care to meet the diverse needs of patients. The study's outcomes could benefit from a more pronounced emphasis on articulating prospective interventions on the use of tele-nursing in specific clinical domains (e.g.: diabetes control) and the definition of new training policies. Future work should assess how these perceptions about the new ICTs contribute to improve patient care, the satisfaction of healthcare professionals and the sustainability of the national healthcare system.40

The participating nurses note many positive aspects of the use of tele-nursing, especially for patients, but also for practice management. It is encouraging that they value this resource as a “humaniser” of care, to improve nurse–patient communication and to reach those we cannot reach now. Nurses need support and resources but are highly motivated to apply tele-nursing in their daily work in Primary Care.

This project has been approved by the Ethics Committee of the Catholic University of Valencia with the code UCV/2022-2023/001 and informed consent was obtained from all participants.

The authors received no financial support for the research, authorship, and/or publication of this article.

The authors of this article declare that they have no conflict of interest in relation to this research.