The understanding and knowledge gained from our analysis explained how nurses’ experienced person-centred care and competence in digital care meetings expanded as a process of development, following their education on digital competence. Authentic training during the course created opportunities for the nurses to develop new ways of working and contributed to their know-how about clinical activities and, in turn, their confidence and openness. The transition from physical to digital care meetings, accelerated by the COVID-19 pandemic as a means of maintaining patient contact, altered their work situations and contributed to common care benefits. The rapid introduction also contributed to the nurses’ uncertainty and highlighted their technical inability to support patients at digital care meetings. Increased digital competence, however, created a sense of security that translated into clinical know-how, which encouraged the nurses to increasingly invite more patients to attend digital care meetings and allow a wider range of reasons eligible for such visits. By extension, the nurses’ increased knowledge and sense of security sharpened their skills, especially with support from managers.
In light of the aim to describe nurses’ experiences with person-centred care and competence in digital care meetings over time after participation in the DCC course, the results revealed that nurses’ theoretical knowledge and digital competence via reflections with others advanced from novice to expert [25] and the nurses changed from being technically inept to being able to concretely help colleagues and patients with digital care meetings. The nurses described that the ongoing pandemic had contributed to that development and accelerated the introduction of digital care meetings into their work, and the results indicate how inexperience with digital care meetings in combination with rapid change had left the nurses unprepared for their new professional situation. This situation was characterised by fears and anxieties that initially focused on technical obstacles. Studies have indicated that digital technology in care changes the role of nurses, which can both reduce and crate stress for nurses [26, 27]. At the same time, nurses play a significant role in supporting patients’ use of digital technology, an activity in which a lack of support pushes patients away [28–30]. Taken together, the evidence suggests that nurses are increasingly embracing a professional role that involves using digital technology and necessitates conditions that broaden their area of knowledge. According to Shepard-Law et al. [31], knowledge develops from theory via reflection about one’s and others’ experiences. In parallel, the opportunity to identify oneself as a novice in a new work situation despite having another level of knowledge in a different domain increases one’s sense of security [25, 32, 33]. Benner [25, 33] described how having experience and expertise in certain areas makes it easier to be a novice in new tasks where previous experience is lacking. However, according to Friesen-Storms et al. [34], ignorance and negative attitudes are barriers to integrating knowledge into clinical practice. Accordingly, education across one’s professional life is crucial to developing competence via a reflexive approach, which requires understanding one’s opportunities for development and being open to new ways of working.
The results show that interactions in care meetings shifted from depending on physical proximity to building proximity despite the distance. Although they had limited experience with digital care meetings, the nurses had extensive experience with physical care visits, which helped them develop the ability to remotely ensure a feeling of closeness in the care relationship with patients. According to Ekman et al. [2], PCC based on joint reconciliation requires a documented care plan, involves the patient, and increases the patient’s participation. In contrast, patients who are not treated based on their own perceptions often continue to seek care [35]. These findings are congruent with Epstein and Street [36], namely, that PCC meetings require knowledge, the ability to focus on the patient, and an understanding of the patient’s experiences and needs. Such a conscious presence is created via reciprocity, communication, and interaction [37, 38]. Benner [39] added that nurses’ perceptual ability and judgement based on each step in developing competencies result from experiential learning acquired from meetings with patients. This dynamic suggests that developing experience, compassion, and support enables good nursing and PCC regardless of whether care meetings occur in person or digitally.
In our study, the digital care meetings allowed the nurses to reduce their travel time and home visits, which increased the number of digital patients visits they could make and provided a more flexible workday. Additionally, the patients’ reduced travel time to care facilities also increased their independence and access to care. Benner [33] observed that when nurses collaborate and integrate their work teams into their strategies for efficiency, patients’ treatment benefits. In another work, Morley and Cashell [40] found that collaboration increases the efficiency and the quality of care, while Wilkes et al. [41] highlighted that digital cooperation benefits from a clear division of roles and in turn creates socioeconomic benefits. Such observations suggest that digital care meetings, which presuppose cooperation and organisational adaptation, provide better resource utilisation in the form of increased care contact. As a result, the quality of care improves, and sustainable socioeconomic benefits with the distribution of human and monetary resources become possible.
Our results also showcase that the nurses were accustomed to centring care around their patients. Thus, that trend may indicate that care meetings risk becoming imbalanced to the point where patients feel dependent upon the provider. Research has shown that increased accessibility to care contributes to equal care and benefits from nurses’ ability to integrate technology and refine their working methods [42–44]. These results suggest that a patient’s dependency decreases with transparency but increases with digital access to care.
Last, our results highlight the importance of managers in developing new working methods by providing the necessary financial resources and inspiring professional development. According to Benner [25, 33], a lack of recognition from managers can lead to difficulties for nurses in understanding their professional role and professional performance. This dynamic aligns with the conclusions of Huy [45] that managers are members of organisations capable of relieving the anxiety that staff may feel during processes of change. At the same time, Carlström [46] described how managers in health care often have experience as health care providers themselves but lack managerial training and thus identify with staff and patients, which risks a conflict of loyalty when they face bureaucracy and questions about financial resources. Other research has shown that an organisation’s adaptation to change depends on managers’ ability to foster participation and a supportive culture [47, 48].
Methodological limitations
The eight participants were interviewed twice, and the relatively small sample was compensated by rich, nuanced interviews. The sample size does not necessarily matter when a study’s results are the sum of the richness of the collected material, which can be increased by conducting longer, more in-depth interviews [cf. 20]. The trustworthiness of studies increases with a sample showing variation in age, gender, and experience [20, 23, 49]. The sample consisted only of women, and even if such homogeneity reflects the gender distribution of nurses in Sweden, it could nevertheless be a limitation. As with most qualitative research, the results should be considered in the contexts where they emerged and cannot necessarily be generalised to other settings or screenings. Some researchers criticise the inductive and descriptive approaches for summarising empirical data without providing new insights. However, the results contribute to a new understanding and knowledge of how nurses experience person-centred care in digital care meetings expanded as a process of development following education in digital competence [cf. 20, 23, 50–51].