Dissertations and Theses (Open Access)

Date of Award

Spring 5-2026

Degree Name

Doctor of Philosophy in Nursing (PhD)

Advisor(s)

Maja Djukic PhD

Second Advisor

Carina Katigbak PhD

Third Advisor

Eduardo Salas, PhD

Abstract

Background: Advancing technologies and the use of telehealth have expanded in hospitals to include telenursing. Telenursing introduces a unique dynamic where virtual and bedside nurses work together as a remote team to provide patient care. Published literature reports that teamwork among nurses and healthcare professionals impacts patient and workforce outcomes. However, there is a gap in exploring teamwork between virtual and bedside nurses. Addressing this knowledge gap is critical to ensure positive patient and nursing workforce outcomes in hospital-based telenursing settings.

Objective: To generate a grounded theory that explains teamwork between virtual and bedside nurses in the hospital setting. A secondary aim is to explore the experiences of teamwork in telenursing with the elderly inpatient population. Design: Researchers used the Constructivist Grounded Theory methodology for this study.

Participants: Virtual nurses, bedside nurses, and nurse leaders who work within a virtual nursing model to provide care to hospitalized patients in the United States.

Methods: Purposive and theoretical sampling approaches were employed. Researchers collected data through one-on-one virtual interviews, which were recorded and transcribed, and supplemented with field notes. The principal investigator employed constant comparative methods and memo-writing throughout the coding process and theory development. The researchers validated the resulting theory against the raw data, existing theoretical frameworks, and with member checking to increase rigor and trustworthiness.

Results: Twenty-two nurses participated in the study, of which eleven were virtual nurses, eight were bedside nurses, and three were nurse leaders. The core category, Bridging Distance in Teamwork, conceptualizes teamwork between virtual and bedside nurses. This theory includes six interrelated categories and 19 properties: (1) Integrating Workflows (aligning technology and workflows, needing shared situational awareness, understanding role context, and leaders championing virtual nursing), (2) Working Interdependently (contributing to workload relief and care quality, being receptive to support, providing a safety net, and adapting), (3) Humanizing (knowing one another, extending grace, and cultivating rapport), (4) Orchestrating Effective Communication (closing communication loops, tailoring communication, and communicating intentionally), (5) Exercising Trust (recognizing clinical credibility and demonstrating reliability over time), and (6) Cultivating Remote Cohesion (actively engaging across roles, expressing mutual respect and appreciation, and holding a shared mindset).

Conclusion: This research fills a gap in the published literature and contributes to nursing knowledge by outlining the theory of bridging distance in teamwork between virtual and bedside nurses. The identified categories and properties influence one another to bridge the distance in teamwork between virtual and bedside nurses.

Keywords

virtual nursing, telenursing, grounded theory, teamwork, nursing teamwork, virtual teamwork

Included in

Nursing Commons

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