DIGITAL HEALTH TECHNOLOGIES AND THE NURSE–PATIENT RELATIONSHIP: INSIGHTS FROM SOUTH AFRICAN HOSPITALS
DOI:
https://doi.org/10.20319/icssh.2026.3954Keywords:
Digital Health Technologies, Nurse-Patient Relationship, Normalisation Process Theory, Healthcare Integration, Patient-Centered CareAbstract
This study explores how technology shapes the nurse-patient relationship, enhancing efficiency, responsiveness, and monitoring while posing risks to personal interaction. Guided by Normalization Process Theory (NPT), a qualitative interpretive design was used to examine nurses’ experiences with digital health technologies (DHTs) in two Western Cape hospitals. Using purposive sampling, 28 participants provided in-depth insights analysed thematically. Findings show that DHTs improved efficiency, accuracy, and patient monitoring but also reduced face-to-face interaction, increased administrative tasks, and required ongoing training. Administrators valued DHTs’ strategic benefits yet stressed the need to address relational and practical challenges. Overall, the study reveals the dual impact of DHTs - enhancing efficiency while challenging relational care - and offers insights into balancing digital innovation with patient-centered practice in South African hospitals during crises, but offers novel insight into its importance. These findings highlight the strategic value of developing communication skills.
References
Ajibulu, L., Chappell, K., Seow, C., Goodman, K., & Wong, K. (2025). “Simpleness”: A qualitative description study exploring patient perspectives on the barriers and facilitators of using digital health tools to self-manage inflammatory bowel disease. Therapeutic Advances in Gastroenterology, 18. https://doi.org/10.1177/17562848251319807
Barnard, A., & Sandelowski, M. (2001). Technology and humane nursing care: (Ir) reconcilable or invented difference? Journal of Advanced Nursing, 34(3), 367–375. https://doi.org/10.1046/j.1365-2648.2001.01768.x
Bhamjee, A., Roux, T., Swanepoel, D., Graham, M., Schlemmer, K., & Mahomed-Asmail, F. (2022). Perceptions of telehealth services for hearing loss in South Africa’s public healthcare system. International Journal of Environmental Research and Public Health, 19(13), 7780.
https://doi.org/10.3390/ijerph19137780
Bhattacherjee, A. (2012). Social science research: Principles, methods, and practices (2nd ed.). University of South Florida.
http://scholarcommons.usf.edu/oa_textbooks/3
Bouamrane, M., Osbourne, J., & Mair, F. (2011). Understanding the implementation and integration of remote and tele-health services: An overview of normalization process theory. PervasiveHealth 2011.
https://doi.org/10.4108/icst.pervasivehealth.2011.246039
Bridges, J., Nicholson, C., Maben, J., Pope, C., Flatley, M., Wilkinson, C., Tziggili, M. (2013). Capacity for care: Meta-ethnography of acute care nurses’ experiences of the nurse–patient relationship. In Patient–provider interactions: Analysing communication in medical encounters (pp. 65–77). Palgrave Macmillan. https://doi.org/10.1057/9781137308931_6
Cresswell, K. M., Worth, A., & Sheikh, A. (2012). Integration of a nationally procured electronic health record system into user work practices. BMC Medical Informatics and Decision Making, 12(1), Article 15.
https://doi.org/10.1186/1472-6947-12-15
Feroz, A., Afzal, N., & Seto, E. (2022). Exploring digital health interventions for pregnant women at high risk for pre-eclampsia and eclampsia in low-income and middle-income countries: A scoping review. BMJ Open, 12(2), e056130. https://doi.org/10.1136/bmjopen-2021-056130
Gauthier-Beaupré, A., & Grosjean, S. (2023). Understanding acceptability of digital health technologies among francophone-speaking communities across the world: A meta-ethnographic study. Frontiers in Communication, 8, Article 1230015. https://doi.org/10.3389/fcomm.2023.1230015
Gilardi, S., Guglielmetti, C., & Pravettoni, G. (2013). Interprofessional team dynamics and information flow management in emergency departments. Journal of Advanced Nursing, 70(6), 1299–1309.
https://doi.org/10.1111/jan.12284
Gupta, N., Dixit, T., & Kate, V. (2016). Factoring digital health for improved outcomes in management of noncommunicable diseases. Journal of Social Health and Diabetes, 4(2), 102–107.
https://doi.org/10.4103/2321-0656.187998
Han, J., Kim, M., Ryu, K., & Shin, K. (2024). Acceptance of digital health care technology and the role of nursing education. The Journal of Continuing Education in Nursing, 55(12), 575–587.
https://doi.org/10.3928/00220124-20241107-03
Hatch, A., Hoffman, J., Ross, R., & Docherty, J. (2018). Expert consensus survey on digital health tools for patients with serious mental illness: Optimizing for user characteristics and user support. JMIR Mental Health, 5(2), e46.
https://doi.org/10.2196/mental.9777
Hooker, L., Small, R., Humphreys, C., Hegarty, K., & Taft, A. (2015). Applying normalization process theory to understand implementation of a family violence screening and care model in maternal and child health nursing practice: A mixed methods process evaluation of a randomised controlled trial. Implementation Science, 10, Article 23. https://doi.org/10.1186/s13012-015-0230-4
Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. https://doi.org/10.1177/1049732305276687
Janssen, R., Engel, N., Krumeich, A., Esmail, A., Dheda, K., Thomas, R., … Pai, N. (2025). How to make an app-based program work and show how it works. PLOS Global Public Health, 5(9), e0005034.
https://doi.org/10.1371/journal.pgph.0005034
Kavaklı, Ö. (2016). Two examples of nursing working system in emergency medical services. Eurasian Journal of Emergency Medicine, 15(1), 44–47. https://doi.org/10.5152/eajem.2016.78557
Kwame, A., & Petrucka, P. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC Nursing, 20(1), Article 158.
https://doi.org/10.1186/s12912-021-00684-2
Livesay, K., Petersen, S., Walter, R., Zhao, L., Butler-Henderson, K., & Abdolkhani, R. (2023). Sociotechnical challenges of digital health in nursing practice during the COVID-19 pandemic: National study. JMIR Nursing, 6, e46819.
Maita, K., Maniaci, M., Haider, C., Ávila, F., Torres-Guzman, R., Borna, S., Forte, A. (2024). The impact of digital health solutions on bridging the health care gap in rural areas: A scoping review. The Permanente Journal, 28(3), 130–143. https://doi.org/10.7812/TPP/23.134
Marra, C., Chen, J., Coravos, A., & Stern, A. (2020). Quantifying the use of connected digital products in clinical research. NPJ Digital Medicine, 3(1), Article 8. https://doi.org/10.1038/s41746-020-0259-x
May, C., Cummings, A., Girling, M., Bracher, M., Mair, F., May, C., Finch, T. (2018). Using normalization process theory in feasibility studies and process evaluations of complex healthcare interventions: A systematic review. Implementation Science, 13(1), Article 78.
https://doi.org/10.1186/s13012-018-0758-1
May, S., Muehlensiepen, F., Wengemuth, E., Seifert, F., Heinze, M., Bruch, D., Spethmann, S. (2025). Benefits and barriers to mHealth in hypertension care: Qualitative study with German health care professionals. JMIR Human Factors, 12, e52544. https://doi.org/10.2196/52544
McEvoy, R., Ballini, L., Maltoni, S., O’Donnell, C., Mair, F., & MacFarlane, A. (2014). A qualitative systematic review of studies using the normalization process theory to research implementation processes. Implementation Science, 9(1), Article 2. https://doi.org/10.1186/1748-5908-9-2
Merino, M., Barrio, J., Nuño-Solinís, R., & Rodríguez, M. (2024). Value-based digital health: A systematic literature review of the value elements of digital health care. Digital Health, 10, 1–17.
https://doi.org/10.1177/20552076241277438
Mueller, D. (2020). Addressing the challenges of implementing a health technology assessment policy framework in South Africa. International Journal of Technology Assessment in Health Care, 36(4), 453–458.
https://doi.org/10.1017/S0266462320000562
Murray, E., Treweek, S., Pope, C., MacFarlane, A., Ballini, L., Dowrick, C., … May, C. (2010). Normalisation process theory: A framework for developing, evaluating and implementing complex interventions. BMC Medicine, 8(1), Article 63. https://doi.org/10.1186/1741-7015-8-63
Nagel, D., Pomerleau, S., & Penner, J. (2012). Knowing, caring, and telehealth technology. Journal of Holistic Nursing, 31(2), 104–112.
https://doi.org/10.1177/0898010112465357
Nordmark, S., Zingmark, K., & Lindberg, I. (2016). Process evaluation of discharge planning implementation in healthcare using normalization process theory. BMC Medical Informatics and Decision Making, 16(1), Article 48.
https://doi.org/10.1186/s12911-016-0285-4
Özaras, G., & Abaan, S. (2016). Investigation of the trust status of the nurse–patient relationship. Nursing Ethics, 25(5), 628–639.
https://doi.org/10.1177/0969733016664971
Pepito, J. A., & Locsin, R. (2019). Can nurses remain relevant in a technologically advanced future? International Journal of Nursing Sciences, 6(1), 106–110. https://doi.org/10.1016/j.ijnss.2018.09.013
Philippe, T., Sikder, N., Jackson, A., Koblanski, M., Liow, E., Pilarinos, A., … Vàsàrhelyi, K. (2022). Digital health interventions for delivery of mental health care: Systematic and comprehensive meta-review. JMIR Mental Health, 9(5), e35159. https://doi.org/10.2196/35159
Reilly, J., Krause, K., Zande, C., & Knutzen, B. (2019). Implementing relationship-based care as a professional practice model: Promoting nurses’ understanding and confidence to apply in practice. Creative Nursing, 25(4), e36–e43.
https://doi.org/10.1891/1078-4535.25.4.e36
Sari, N., & Mustamu, A. (2023). Analysis of factors related to the accuracy of triage assessment at the emergency room. Journal of Health Sciences, 16(3), 325–336. https://doi.org/10.33086/jhs.v16i03.5084
Saunders, M., Lewis, P., & Thornhill, A. (2019). Research methods for business students (8th ed.). Pearson Education.
Schmalz, O., Jacob, C., Ammann, J., Liss, B., Iivanainen, S., Kammermann, M., … Popescu, R. (2020). Digital monitoring and management of patients with advanced or metastatic non-small cell lung cancer treated with cancer immunotherapy and its impact on quality of clinical care: Interview and survey study among health care professionals and patients. Journal of Medical Internet Research, 22(12), e18655. https://doi.org/10.2196/18655
Strandås, M., & Bondas, T. (2017). The nurse–patient relationship as a story of health enhancement in community care: A meta-ethnography. Journal of Advanced Nursing, 74(1), 11–22.
https://doi.org/10.1111/jan.13389
Taft, A., Hooker, L., Humphreys, C., Hegarty, K., Walter, R., Adams, C., Small, R. (2015). Maternal and child health nurse screening and care for mothers experiencing domestic violence (MOVE): A cluster randomised trial. BMC Medicine, 13(1), Article 150. https://doi.org/10.1186/s12916-015-0375-7
Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042
Turpin, L., McWilliam, C., & Ward-Griffin, C. (2012). The meaning of a positive client–nurse relationship for senior home care clients with chronic disease. Canadian Journal on Aging, 31(4), 457–469.
https://doi.org/10.1017/S0714980812000311
Wong, P., Brand, G., Dix, S., Choo, D., Foley, P., & Lokmic-Tomkins, Z. (2023). Preregistration nursing students’ perceptions of digital health technology on the future of nursing. Nurse Educator, 49(4), E208–E212.
https://doi.org/10.1097/NNE.0000000000001591
Wu, Q., & Street, R. (2020). Factors affecting cancer patients’ electronic communication with providers: Implications for COVID-19-induced transitions to telehealth. Patient Education and Counseling, 103(12), 2583–2587. https://doi.org/10.1016/j.pec.2020.09.036
Yue, M., Yao, C., Zhang, Q., & Zeng, D. (2025). Nurses’ attitudes towards communication with patients: A hybrid concept analysis. BMC Medical Education, 25(1). https://doi.org/10.1186/s12909-025-07914-0
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