Blended community nursing care: towards a new normal? Process evaluation of a large-scale implementation

BACKGROUND: Blended care, combining in-person and digital support through various care technology devices, represents a promising yet underutilized approach in community nursing. Its successful adoption requires major workflow adaptations. Previous studies have highlighted the need to evaluate the usability, feasibility, and effectiveness of implementation strategies for blended care to ensure their successful integration. The aim of this study was to examine the implementation of a comprehensive blended care package, offering around 40 devices across care domains via a single supplier, within a large Dutch community care organization, and explored what healthcare professionals (HCPs) and clients need to optimize its use. METHODS: Data were collected through observations of implementation activities (four training sessions, five counselling sessions, and four care needs assessments) and semi-structured interviews with eleven HCPs and five clients. Training covered information on blended care and demonstrations of ten devices. Counselling focused on identifying suitable clients and clarifying device use. Data were thematically analysed, guided by the Medical Research Council- and Capability-Opportunity-Motivation model. RESULTS: HCPs were introduced to various devices, with no opportunity to test devices. In three care needs assessments, nurses and clients showed uncertainty about device functionality. HCPs valued the introductory training and counselling sessions and acknowledged the benefits of blended care, including increased client autonomy. HCPs expressed a preference for testing care technologies before introducing them to clients. Some reported concerns about job loss or unwanted changes in their roles. In general, clients were initially hesitant but ultimately appreciated its effectiveness. CONCLUSION: Blended care was implemented per the organization's strategy, ensuring HCPs were informed, able to ask questions, and encouraged to engage in discussions. However, insufficient product knowledge and concerns about integrating blended care might have influenced adoption, highlighting the need for improved knowledge transfer and implementation support. Guidelines may support healthcare organizations and HCPs in facilitating successful implementation.