Nurse‐Assisted Remote Patient Monitoring for Self‐Management Support to Patients With Long‐Term Illness—A Qualitative Multimethod Study

ABSTRACT

Aim

To explore patients and nurses' experiences of digital self‐management support following participation in a remote patient monitoring intervention.

Design

An exploratory qualitative multimethod study.

Methods

The study was conducted at two Norwegian university hospitals between January 2022 and February 2023. Data were obtained through semistructured interviews of 17 patients with heart failure, 10 patients surgically treated for colorectal cancer and eight nurses. The data collection also included excerpts from chat messages between patients and nurses obtained from the digital platform during January and February 2024. Data were analysed using abductive thematic analysis.

Results

The analysis revealed three themes: (1) raising illness awareness through RPM technology, (2) establishing a mutual collaboration in self‐management challenges and (3) fostering a continued engagement in health behaviour change. The themes captured patients and nurses' experiences of receiving and providing digital self‐management support. The analysis also identified a unifying key theme: ‘bridging technology and self‐management support through remote caring encounters’, which firmly connected the three themes.

Conclusion

Remote patient monitoring appeared to benefit both patients and nurses by altering patients' self‐management routines and the nurses' workflows. Furthermore, applying the theory of technological competency as caring in nursing to remote patient monitoring interventions may help ensure that the patient–nurse relationship is not weakened as technology advances.

Implications for the Profession and Patient Care

Remote patient monitoring interventions have the potential to become a valuable tool in modern healthcare, enabling effective communication and collaboration between patients and nurses while also ensuring patient‐centred care. However, future development of remote patient monitoring interventions should include nursing support.

Impact

This study addresses remote patient monitoring and digital self‐management support from the perspectives of both patients and nurses. The findings may have an impact on remote nursing, patient satisfaction and strategies to improve digital follow‐up care for patients with long‐term illnesses.

Reporting Method

The authors adhered to the EQUATOR guidelines through the SRQR reporting method.

Patient or Public Contribution

No patient or public contribution.

Summary.

• What does this paper contribute to the wider global clinical community?

  • ○
    This study provides valuable insight into patients and nurses' experiences with digital self‐management support via remote patient monitoring after hospital discharge.
  • ○
    The findings demonstrate that nurse‐assisted remote patient monitoring enables targeted and personalised follow‐up care, early detection of health deterioration and a caring and mutually beneficial relationship between patients and nurses.

1. Introduction

Nurses play a pivotal role in providing self‐management support to patients with long‐term illnesses (Chan et al. 2023). Supporting patients' self‐management is critical for achieving positive outcomes in long‐term illnesses (Facchinetti et al. 2020). Self‐management refers to the process of controlling one's own health, promoting health and living well with illness (Battersby, Lawn, and Pols 2010) whereas self‐management support involves HCPs (Health Care Professionals) systematically providing education and supportive strategies to help patients build the skills and confidence needed to effectively manage their health problems (Adler et al. 2008). Caring is fundamental in nursing and manifest as the genuine, intentional presence of a nurse with the person being cared for (Locsin 2016). Furthermore, in modern healthcare, specialised technologies infiltrate all areas of care and nurses are expected to engage in a broad range of technological and digital activities when providing nursing care (de Jong, Donelle, and Kerr 2020). These technologies, such as remote patient monitoring (RPM), can affect human health and offer new opportunities to better understand patients' needs (Wynn et al. 2023). RPM enables nurses and other HCPs to remotely monitor patients' physiological (e.g., vital signs, weight and blood pressure) and psychosocial (e.g., self‐reported quality of life) data, provide clinical feedback and intervene if problems arise (Serrano et al. 2023). It may also improve patient care and patients' self‐management skills (Farias et al. 2020). However, nurses may have difficulties maintaining their care practices while attempting to meet complicated and competing technological expectations. There is also a possibility that the focus of treatment moves from the patient and patient care to the technology itself (Krel et al. 2022), and thus increases a gap in the interpersonal relationship between the nurse and patient (Locsin 2016). To bridge this gap, modern nurses may benefit from practicing nursing care grounded in an explicit nursing theory that integrates technology and patient‐centred nursing practice, such as the theory of technological competency as caring in nursing (TTCCN).

2. Background

Heart failure (HF) and colorectal cancer (CRC) are non‐communicable diseases (NCDs), that is, illnesses characterised by their non‐transmissible occurrence and long‐term duration, lasting 3 months or more (World Health Organization 2021). Both HF and CRC necessitate continuing medical care, lifestyle changes and psychosocial support after the initial stages of diagnosis and treatment phases (Lo et al. 2021; Zaharova et al. 2022). Due to a growing worldwide population of NCDs and a decline in nurses to provide care, increasing attention is being paid to the self‐management of long‐term illnesses. Currently, it is expected that patients living with long‐term illnesses actively participate in their healthcare management (Anekwe and Rahkovsky 2018). For long‐term illnesses, self‐management includes specific skills and tasks, some of which are universal for all self‐management behaviours, such as symptom management, adherence to treatment regimens, commitment to appropriate lifestyle changes, the ability to deal with psychological and physical consequences of the illness and establishing a well‐functioning patient–nurse relationship (Van Hecke et al. 2017). Other skills and tasks are illness specific, such as patients with CRC adjusting to a chronically changed bowel function or patients with HF titrating diuretics to avoid fluid retention or reduce oedemas. However, self‐management of long‐term illnesses is difficult for many patients, and the period immediately following hospital discharge is described as particularly challenging, with a need for continuing support and collaboration with the healthcare system (Brandberg, Ekstedt, and Flink 2021). Moreover, the information given to patients with HF and to patients with CRC before hospital discharge has been declared deficient (Wathne et al. 2023). As a result, many patients struggle to adhere to post‐discharge recommendations, manage medications or recognise illness deterioration or complications (Brandberg, Ekstedt, and Flink 2021; Facchinetti et al. 2020; Wathne et al. 2023). Thus, when dealing with a long‐term illness, receiving proper support is crucial (Anekwe and Rahkovsky 2018). Providing support to patients is an important task for nurses. Given some patients' challenges in properly managing their illness post‐discharge, the need for collaboration with nurses on how to adequately self‐manage during this period cannot be overstated (Anekwe and Rahkovsky 2018; Facchinetti et al. 2020).

Digital self‐management support may be provided by various RPM systems, such as electronic devices (e.g., websites and apps) or a monitoring system (e.g., a smartwatch). These systems can be used to stimulate a positive health behaviour change or support the treatment and care of diseases (Kampmeijer et al. 2016). RPM has the advantage of providing real‐time detection of an illness and exacerbation and the ability to continually monitor patients' health conditions. It also provides the means to support communication between nurses and patients, transfer information, improve clinical outcomes, such as physical and functional status among users, and facilitate patient self‐management (Serrano et al. 2023). Furthermore, remote digital technologies have been shown to significantly benefit patients who are expected to self‐manage at home by enhancing patients' awareness and confidence in self‐management (Korpershoek et al. 2018). Moreover, patients may obtain repeated and continuous information if they are given access to nurse competency through an RPM solution following hospital discharge which further may improve their self‐management abilities. However, for RPM to grow in importance and value in future healthcare services, research is needed on how RPM can be a tool for nurses in the provision of self‐management support and to collect crucial information from patients to strengthen nurses' clinical decision‐making processes. Furthermore, it is unclear how patients with long‐term illness may benefit from remote self‐management support in the initial period after hospital discharge (Brandberg, Ekstedt, and Flink 2021). Additionally, remote encounters pose the risk of losing human connections. TTCCN emphasises a holistic approach to patient care that considers both technological and human elements, with a specific emphasis on the significance of maintaining human connection and empathy when using technology (Barchielli et al. 2021), which is especially relevant in RPM. Furthermore, by stressing patient empowerment through technology and encouraging continuing learning and adaption, TTCCN appears to align with numerous aspects of self‐management support. As a result, the current study draws on TTCCN.

2.1. The TTCCN

TTCCN takes a collaborative nurse–patient perspective and it is framed largely within the concepts of nursing, technology and caring (Nakano et al. 2019). The theory, which may be applied in nursing environments where technology is being used, posits that technological competence and nursing care are not opposing forces, but rather coexists harmoniously (Krel et al. 2022). Moreover, the TTCCN addresses three main phenomena: (1) caring for, which is based on nursing experience; (2) being cared for, which is based on the patient experience; and (3) technology, which relates to the instruments that nurses use in practice. Adopted from Locsin (Locsin 2016), the three main phenomena of TTCCN are illustrated in Figure 1.

FIGURE 1.

An overview of the main phenomena of the theory of technological competency as caring in nursing.

In TTCCN, nursing is not viewed as a process of performing precise actions or interventions. Instead, it is defined as a series of events that unfold unpredictably as dynamic engagements of knowing persons in a technological encounter (Locsin 2016). TTCCN defines dynamic engagements as the interactive and collaborative relationships between nurses and patients, whereas technological encounters may be understood as dynamic engagements of knowing persons using technology (i.e., the nurse understands the patient using information gathered through technology) (Locsin 2016). Furthermore, knowing persons is a multidimensional process that includes three concurrent events that serve to guide nurses in their practice. These events are referred to as technological knowing, which is a way of understanding patients' needs through the competent use of technology, including physical and emotional needs (Krel et al. 2022). Mutual designing refers to a process in which the nurse and the patient collaborate to create a nursing care process that is designed by both the nurse and the patients and practiced as nursing together (Locsin and Purnell 2015). Participative engaging offers possibilities for shared activities, during which nurse and patient alternate between implementation and evaluation. The key concepts from TTCCN used in this study are presented and illustrated in Figure 2.

FIGURE 2.

A visual figure of the key concepts from the theory of technological competency as caring in nursing that were applied in this study.

3. The Study

3.1. Aims

The purpose of this multi‐method study was to explore patients' and nurses' experiences with technology‐supported self‐management in an RPM intervention following hospital discharge. Furthermore, in the context of technology‐assisted healthcare, TTCCN may provide a framework for understanding and improving the co‐existence of technology and care in the nurse–patient relationship. To our knowledge, this is the first study to use TTCCN as a framework in RPM technology within the context of long‐term illness.

3.2. The Research Project ‘Nurse‐Assisted eHealth Service From Hospital to Home’

This study is part of a larger research project: Nurse‐Assisted eHealth Service from Hospital to Home: Ameliorating the Burden of Treatment among Patients with Non‐Communicable Diseases. The project includes three phases: (1) modelling the nurse‐assisted RPM intervention, (2) evaluating the intervention's feasibility and (3) carrying out a randomised controlled trial (Husebø et al. 2019). The current study, conducted during the second phase of the main project, is the second study to examine the intervention's feasibility. The first study evaluated the acceptability and usability of the RPM intervention (Wathne et al. 2024). However, because the experiences with digital self‐management support were regarded valuable in determining the feasibility of the RPM intervention, the current study was conducted.

3.3. The Nurse‐Assisted RPM Intervention ‘eHealth@Hospital‐2‐Home’

The nurse‐assisted RPM intervention was a non‐acute, 30‐day post‐hospitalisation intervention that used a wireless, portable personal computer system (iPad) with a patient application (My Dignio) installed (www.dignio.com). The application connected to monitoring devices via Bluetooth and registered clinical measurements such as temperature, pulse, blood pressure and weight. The intervention was operated by experienced hospital nurses, referred to as nurse navigators in the current project, with clinical skills and technological competency to identify and monitor the healthcare needs of patients with HF and CRC (Morken et al. 2023). My Dignio allowed patients to register self‐reported symptoms and well‐being, in addition to clinical measurements. The nurse navigator's application, Dignio Prevent, allowed the nurse navigators to read the measurements and symptom registrations and provide feedback and support to the patients. Furthermore, the patient application was generically designed, that is, the user interface was similar regardless of patient group. However, as a result of the projects' modelling phase, the features and content of the patient application were tailored to each individual patient group (Morken et al. 2023; Wathne et al. 2023).

4. Methods

4.1. Design and Setting

The current study used two distinct qualitative methods in an exploratory, sequential design (O'Reilly, Kiyimba, and Drewett 2021): semistructured interviews with patients and nurse navigators (Kvale and Brinkmann 2015) and excerpts from their online chat message conversations (Morgan 2022). However, the two qualitative components were not weighted equally. The semistructured interviews formed the core component, whereas the documents containing chat message conversations served as a supplemental component, providing explanations and insights into the interview context. This is also known as a QUAL‐qual design (Morse 2017).

The process of studying a single phenomenon using multiple methods, either within or across methodologies or data collection methods and/or data sources, is referred to as triangulation (Campbell et al. 2020). Triangulation has proven beneficial in providing more comprehensive data, confirmation of data and an enhanced understanding of the studied phenomena. Therefore, it is used as a strategy in qualitative research to increase the trustworthiness of the study (Adler 2022). The current study used triangulation within the methodology (i.e., all qualitative), between the data collection methods (i.e., interviews and chat message conversations) and across two stakeholder groups (i.e., data triangulation) (Campbell et al. 2020). Furthermore, the standards for reporting qualitative research (SRQR) method was used for reporting the findings of this study.

4.2. Participants and Recruitment

The clinical setting for this study was two university hospitals in Norway, hospital A in the southwest and hospital B in the middle. The study's patient populations were a purposive sample of patients with medically and surgically treated long‐term illnesses, that is, HF and CRC, who had participated in the feasibility evaluation of the RPM intervention eHealth@Hospital‐2‐Home. The selection criteria for the study were being ≥ 18 years old, having the ability to understand and speak the Norwegian language, and being hospitalised due to either symptomatic HF with an ejection fraction ≤ 40% or having received curative surgical treatment due to CRC. Patients with HF were recruited from cardiology bedside wards situated at hospitals A and B. Patients with CRC were recruited from a gastro‐surgical bedside ward at hospital A. Before discharge from the hospital, one of the nurse navigators contacted the patients to inquire about their participation in the study. The patients were shown an informational video in which the intervention was thoroughly illustrated (https://www.youtube.com/watch?v=pT2NhK_jAAU), as well as an information and consent letter from the nurse navigator before consenting to participate. Following consent, and before hospital discharge, the patients were trained in how to use the iPad, the My Dignio patient application and the home monitoring devices.

The nurse navigators were also participants in the study. They received training in the Dignio Prevent user interface from a representative from the technology supplier. The training was organised into physical sessions or via the Microsoft Teams platform (version 1.0.1). Table 1 summarises participant demographics (n = 35).

TABLE 1.

Characteristics of the study participants (N = 35).

Patients (n = 27)
Age in years, mean (range)	69 (48–85)
Sex, female—n	8
Population
Heart failure—n	17
Colorectal cancer—n	10
Nurse navigators (n = 8)
Age in years, mean (range)	31 (25–29)
Sex, female—n	7

Note: n, count.

4.3. Data Collection

4.3.1. Semistructured Interviews (Data Set 1, i.e., QUAL Component)

Data were collected in two stages between January 2022 and February 2023. In stage one, the core component of semistructured interviews was conducted to explore the participants' experiences with remote self‐management support. Patients with HF (n = 17) and CRC patients (n = 10) were interviewed following a 30‐day, post‐hospital discharge RPM intervention. The interviews (n = 27) were conducted individually and face to face. The nurse navigators (n = 8) who facilitated the RPM intervention were interviewed after the feasibility study was completed. They were interviewed face to face or, due to long travel distance, by phone or digitally via the communication platform Microsoft Teams (version 1.0.1). Furthermore, during the intervention, the nurse navigators worked in pairs to provide the digital follow‐up. Thus, in order to capitalise on their shared experiences of providing digital self‐management support, the nurse navigators were preferably interviewed in dyads, that is, in pairs (n = 3). The remaining nurse navigators were interviewed individually (n = 2). The first author performed both the patient and the nurse navigator interviews. Each interview lasted 40–60 min and were recorded using a digital recorder and transcribed verbatim by the first author (n = 20) or by a professional transcription service (n = 12). Table 2 summarises the various data collection methods.

TABLE 2.

Summary of data collection methods.

	Individual interviews (n)	Dyadic interviews (n)	Chat messages (n)	Transcription by author (n)	Transcription by service (n)
Patients (N = 27)		n.a.	10	20	7
Heart failure	17		5	14	3
Colorectal cancer	10		5	6	4
Nurse navigators (N = 8)	2	3	8	0	5

A semistructured interview guide developed by the research team was used during the interviews. The interview guide was arranged with open‐ended questions and sub‐probes. Each interview was initiated with the question: What is your overall experience with digital follow‐up care and home monitoring? The interviews then continued with questions about receiving and providing digital self‐management support and interactions between patients and nurse navigators. Table 3 provides an overview of the questions from the interview guide.

TABLE 3.

Interview guide.

Patient topic guide What is your overall experience of remote digital follow‐up? What did you experience as most positive and negative about this follow‐up? How did you find the questions on the daily and weekly questionnaires? Can you please give examples of questions you asked the nurse navigator? Can you please say something about the response time of the nurse navigators? Can you say something about your level of knowledge on your illness now compared to before? Can you say something about your interaction with the nurse navigators?

Nurse navigator topic guide What is your overall experience of remote digital follow‐up? What did you experience as most positive and most negative about this follow‐up? What is your experience of responding to messages or notifications from patients? In your experience, did you manage to provide feedback to the patients within the time frame? Can you say something about your interaction with patients? In your experience, how did you support and guide patients digitally? In your experience, how did you deal with patients' uncertainty and worries?

4.3.2. Online Chat Message Conversations (Data Set 2, i.e., QUAL Component)

Following the interviews, between January and February 2024, stage two of the data collection involved extracting chat message conversations between patients (n = 10) and nurse navigators from the digital platform's chatroom. The data were extracted after the interviews were analysed and used to support and broaden patients' and nurses' experiences with digital self‐management support. As the message exchange extracts illuminated technological encounters between patients and nurses in real time and provided information about how they used the information they gained through the technology, the extracts were purposively sampled, that is, the richest and most complementary message exchanges were chosen and applied (Morgan 2022).

4.4. Data Analysis

This study employed an abductive thematic analysis approach. This combines inductive and deductive reasoning to iteratively explore and interpret data, attempting to provide logical answers and meaningful explanations for phenomena by aligning empirical findings with existing theoretical frameworks (Thompson 2022). The abductive thematic analysis comprised eight steps, including: (1) transcription and familiarisation, (2) coding, (3) labelling of codes, (4) development of themes, (5) theorising, (6) comparison of data sets, (7) data display and (8) writing up the results. The two data sets were analysed separately, with the interviews analysed first. The supplemental component (i.e., chat message conversations) was interpreted and analysed within the core component, meaning that the data from the chat message conversations were only used to elaborate and clarify the results from the interviews (Morse 2017). An inductive approach was used for coding and categorisation. However, when developing themes and an overarching concept (step 4), we used TTCCN as an interpretative theory to conceptualise the findings (Thompson 2022). The interpretation process was primarily conducted by the first author, followed by discussions with the other authors.

In accordance with abductive thematic analysis, the first author became familiarised with the data by performing narrow readings and extracting significant units of words and utterances. Next, the interview transcripts were coded, grouped and categorised using a coding scheme (Thompson 2022). The codes were first grouped into semantic categories to highlight more specific features of the findings. The categories were then contextualised in relation to the TTCCN, revealing additional latent themes. The three concurrent events that, according to the TTCCN, serve to guide nurses in their practice, namely technological knowing, mutual designing and participative designing, significantly influenced the three themes of this study: (1) raising illness awareness through RPM technology, (2) establishing a mutual collaboration in self‐management challenges and (3) fostering a continued engagement in health behaviour change. These themes, each with two supporting categories, reinforced the unifying theme of ‘bridging technology and self‐management support through remote caring encounters.’ The unifying theme reflected the participants' experiences of providing and receiving digital self‐management support. Moreover, when analysing the data from the message exchanges, the themes created from the interview data were used as a starting point, and the data extracts were organised according to these themes to support and extend the findings from the interviews. The analytical process is illustrated in Table 4.

TABLE 4.

Table of analysis.

Theme	Category	Data extract
Raising illness awareness through RPM technology	Identifying complications and symptoms of deterioration	Interviews ‘Quite a few of the patients sent pictures of their surgical wound … whether they looked good or bad’ (Nurse 8) ‘I could go in and check the daily reports. I could see how my condition was 4 days ago … So, if I felt my condition had worsened … if I relapsed, I was able to see it’ (CRC patient 10) ‘I had a lot of pain, I had shortness of breath and I retained a lot of water … and over a few days my condition worsened … and suddenly I gained 4 kg’ (HF patient 12)	Chat message exchange ‘CRC patient 7: [Sends a picture of wound]. My condition is fine, but I developed a hard swelling just above my big scar. Could this be a hernia? I have an appointment at my doctor's office tomorrow to have my stitches removed, so I can check with them Nurse 8: It is a bit difficult to evaluate from a distance, so it's a good thing that you can get it checked at the doctor's office’
	Gaining knowledge from clinical measurements and messages	Interviews ‘I started taking my measurements from day one and then I could see how my weight was … and the temperature … I could immediately see if it was good or bad. I thought it was great. I wouldn't have weighed myself every day otherwise’ (CRC patient 2) ‘You feel safer when you measure your blood pressure every morning and see that it's fine … in that way that feels safer … you see that your blood pressure is ok’ (HF patient 3) ‘Some patients became very stressed when they lost a bit of weight. One lost 2 kg over 3 weeks and was a bit worried. So, I made a nutrition plan with him … that really calmed him’ (Nurse 8)	Chat message exchange ‘CRC patient 3: I'm feverish and nauseated today. Is that normal? Nurse 2: Yes, that is normal. But if your fever rises you should contact me again. Try to drink a lot’ ‘HF patient 7: I need to comment on my weight loss. I eat properly, so that is not the reason. I have had so much edema because my heart has not been pumping adequately. My blood pressure is fine though and I drink a lot of water to spare my kidneys from all the medication Nurse 2: I also think the reason for your weight loss is because you are losing excessive fluid. You should try not to drink more than 1500 cc a day (approx. 10 glasses)’
Establishing a mutual collaboration in self‐management challenges	Handling self‐management difficulties	Interviews ‘We focused a lot on nutrition. Many patients felt they ate to little … they lost weight and had problems … and some retained so much water that their ability to eat were limited’ (Nurse 1) ‘I talked to them about increasing the medication … I was also supposed to be careful about walking in stairs, but I was a bit careless about that … I asked for advice, and they said as long as I didn't walk uphill and with as little strain as possible, I should be ok’ (HF patient 6) ‘When I came home the first day and sat there with a bag of medication, I was like: ‘ok, am I supposed to find out about this all on my own?’ It is like you need a crash‐course … it feels so important to do it correct. And I like to be in control’ (HF patient 16)	Chat message exchange ‘CRC patient 6: I have a problem with my bowel … it has almost completely stopped. I haven't vomited or had any abdominal pain Nurse 4: When you say almost stopped, is there some bowel movement? Or how is it? It could be that your bowel is beginning to stabilise after the surgery … you did have several frequent emptying's if I remember correctly? When was the last time you had a bowel movement? I would try drinking a lot and move around first, and then try Movicol that you can buy without a prescription at the pharmacy and see if that helps CRC patient 6: I went and got Movicol. Took two dosages on Sunday which led to partial emptying. Haven't had any bowel movement since that … that is a day and a half ago. I am feeling a bit of nausea, but I haven't throwed up. I walk around a lot, and I drink a lot, but it doesn't seem to be sufficient’
	Recognising a need for emotional support	Interviews ‘Most patients had general worries about their heart failure. It wasn't necessarily related to their symptoms right here and now, but more like: ‘now I feel worse—how will this turn out in the end?’ It was more of an existential worry … but the conversations with us really helped them … just knowing that they could have a conversation really’ (Nurse 1) ‘I sleep very poorly … I have so many thoughts, especially when I go to bed at night … it was relieving to talk to the nurse navigator, but now I don't want to talk to anybody. I hurt too much’ (HF patient 12)	Chat message exchange ‘Nurse 2: I see that you have ticked off ‘very poor condition’—what has changed since yesterday? You have also full score on leg edemas today—are they swollen when you sit still with your legs raised? When you press your leg with a finger for a few seconds—do you see a clear finger mark? Do you have shortness of breath when you are sitting still? I see that your weight has decreased a bit, so that's positive. Your blood pressure and pulse are also stable HF patient 12: My condition is poor because I don't have hope anymore. I have lost against the healthcare system. Nobody care how awful I'm feeling. Symptoms are irrelevant’
Fostering a continued engagement in health behaviour change	Strengthening confidence to manage illness	Interviews ‘They [the patients] understood a little bit better how the medication worked and what affects their measurements and their heavy breathing. They did get a better understanding of it [the illness]’ (Nurse 2) ‘Remote patient monitoring was great. It shows how much effort one has to put into it himself … water in your lungs … I didn't know that before … that you can monitor your weight, and how quickly it can go one way or the other’ (HF patient 17)	Chat message exchange. ‘Nurse 2: I see that you report about pressure in the chest and heart palpitations. Is that something you usually have? HF patient 6: The reason for that was a high activity level. I'm taking it easy now, so everything is fine again’ ‘HF patient 3: Yesterday I felt a bit tired and I had some heart palpitations, but I completed what I was doing before I drove home and relaxed. Everything went fine Nurse 1: It is great that you are attentive and let us know how you are feeling. Hopefully the palpitations will bother you less now that you have increased your heart medication’
	Committing to self‐management	Interviews ‘Today I weighed myself … I have a new digital scale … and I saw how much I weighed and wrote it in my calendar on my iPhone … I did it to see if my weight had kept stable’ (CRC patient 1) ‘My blood pressure is pretty low because of my heart failure. Sometimes I get dizzy, but I know about it, so I get up in the tempo my body tolerates. I can't exactly jump up’ (HF patient 5)	Chat message exchange ‘Nurse 3: You are doing a good job with your stoma. How is the nutrition going? CRC patient 10: I eat small meals often. Food tastes good, and I eat as I have always done, only more frequent, but liquids also fill me up a bit … and I go for walks every day, which also gives me an appetite’ ‘HF Patient 4: I have walked around the courtyard for a bit today. It has been a great day so far. Nurse 1: That sounds great. Keep on walking’

4.5. Trustworthiness

In qualitative research, key aspects of trustworthiness include credibility, dependability, transferability and confirmability (Adler 2022). The triangulation of combining two data sources (i.e., patients and nurse navigators) and three data collection methods (i.e., individual and dyadic interviews and chat exchange), enhanced credibility because the combination of qualitative methods and data sources provided complementary insights and a more comprehensive understanding of the research topic. Additionally, it corroborated findings by putting the methods in dialogue with one another. This allowed for different perspectives that may otherwise have been overlooked (Aguilar Solano 2020). Moreover, all four co‐authors participated and reflected on the findings, interpretations and recommendations to ensure they were all supported by the data from the study participants. This strengthened the dependability and minimised the possibility of biases. Transferability and confirmability were established by maintaining rigour in the research process, and providing detailed contextual information to readers, allowing them to determine whether the results apply to their or other situations (Aguilar Solano 2020). In the current study, this was accomplished by including detailed descriptions of the contextual situation, data collection methods, the process by which the data were analysed and interpreted and the theoretical framework that facilitated further understanding of the findings. This audit trail allows readers to assess the applicability of the study's results and conclusion to other contexts and settings (Aguilar Solano 2020).

4.6. Ethical Aspects

This study was evaluated by the Norwegian Center for Research Data (ID.NO: 523386) to ensure privacy measures and compliance with relevant regulations. The Regional Ethics Committee deemed the current feasibility study to be exempt (ID.NO: 242405). All participants gave their written consent to participate and were informed of their right to withdraw from the study at any time. All findings have been anonymised.

5. Findings

In this chapter, the findings are presented in a sequential order, with each theme and supporting categories headed. Moreover, the findings from the nurse navigators and the patients are presented together, as this best captures their mutually acknowledging partnership and collaboration in the RPM intervention. Finally, the chapter concludes with a synthesis of the themes into a unified key theme.

5.1. Raising Illness Awareness Through RPM Technology

5.1.1. Identifying Complications and Symptoms of Deterioration

This category details self‐reported experiences of patients and nurse navigators regarding how the RPM intervention increased awareness of symptoms and clinical measurements while also improving comprehension of them. The interview data and the extracts from the chat communication showed that the patients' daily measurements and responses to the symptom questionnaire allowed the nurse navigators to provide patients with personalised and tailored advice and support in real time. Patients reported an improved ability to interpret bodily signals and relate them to their specific condition, as they saw objective data on their vital signs regularly. This newly acquired awareness of one's health status reinforced positive health behaviour in patients and strengthened their ability to self‐manage. Moreover, there appeared to be a mutually beneficial partnership between the nurse navigators and the patients, as illustrated by this nurse navigator:

It was more a road we travelled together with the patients. We learned to know the patients during the process … how they fluctuated … and they learned to know themselves by taking measurements, seeing the changes, and connecting it to weight gain and heavy breathing. (Nurse navigator 2)

Usually, a single measurement or symptom registration was insufficient to provide accurate feedback. However, some patients expanded on their measurements of signs and symptom registrations by adding comments or messages, which enabled the nurse navigators to get a better overview of the patient's situation. Moreover, monitoring daily symptoms and clinical measurements over an extended period made it easier for both nurse navigators and patients to determine what was within the normal range for each patient. In addition, the patients gained confidence in accepting and understanding day‐to‐day fluctuations and changes in their condition. This process of continuous learning and adaption made it more reassuring for them to push themselves in their everyday lives, as expressed by this patient:

It felt so safe. I monitored my blood pressure and pulse. In addition, I observed myself and how my body reacted. When I walked the dog, I would watch how my body handled the strain. I have been walking further and further each day. (Patient with HF 14)

5.1.2. Gaining Knowledge From Clinical Measurements and Messages

This category identifies how RPM created alertness and vigilance towards symptoms and complications and how patients' daily registrations enabled them, as well as the nurse navigators, to observe and evaluate changes over time. Moreover, the nurse navigators were proactive, and by leveraging the data from the RPM service, they were able to intervene at an early stage when they observed changes in the patient's condition. Prompt involvement from the nurse navigators prevented further complications and exacerbations for several of the patients. However, providing digital follow‐up was not always straightforward, as one of the nurse navigators expressed:

Making distinctions … that was difficult … if they gained a bit of weight … or those who always have shortness of breath. And for some, it [the illness] fluctuated a lot during the day. (Nurse navigator 3)

Data from the chat messages showed various communication between patients and nurse navigators. The patients often asked specific questions about measurements, such as a rise or fall in blood pressure and weight, sent pictures of their surgical wounds or described symptom variations before and after activity. The nurse navigators reacted to changes in the patients' everyday measurements and symptom registrations, and often asked them follow‐up questions to obtain more information. Several nurse navigators emphasised the importance of communicating with patients when they noticed discrepancies in signs or symptom registrations. This allowed them to determine whether the patient's condition had worsened. Moreover, some patients appeared to struggle with determining how much and what type of information the nurse navigators required when describing a health concern or a self‐management challenge. As a result, the nurse navigators relied on additional information obtained via the chat message function, or simply called the patients to clarify details about their condition. Nonetheless, the consistency of patients' measurements made it easier for both patients and nurse navigators to detect symptom worsening and deterioration‐related changes. Also, many of the patients were quite vigilant in monitoring their condition and appeared to be aware that complications could arise, as described in this interview:

I was aware that I had lost weight, so I thought it would be ok to keep an eye on that. Also, I needed antibiotics the first week after I was discharged because I had something in one of my surgical wounds … I had an infection, and this [the RPM intervention] helped me monitor that. If I suddenly got a fever, I would know something was wrong … that there could be an infection. (Patient with CRC 1)

5.2. Establishing a Mutual Collaboration in Self‐Management Challenges

5.2.1. Handling Self‐Management Difficulties

This category reflects how the RPM intervention promoted a holistic approach and mutual collaboration in dealing with self‐management challenges. The use of digital technology enabled patients and nurse navigators to communicate with one another, resulting in a close relationship. The RPM service allowed patients to address difficulties, and the nurse navigators to respond appropriately. However, the patients' challenges were frequently complex, and the nurse navigators had to advise on a variety of different issues, as illustrated by this nurse navigator:

The last one we provided follow‐up; we supervised about attending her husband's funeral … how to take care of herself and her illness. (Nurse navigator 7)

The patients in the current study reported a range of physical symptoms and complications. Some patients with HF were completely asymptomatic, and some patients treated for CRC had no post‐operative complications. Other patients with HF struggled to walk more than a few 100 m, while patients with CRC experienced wound infections or leakages. Nutrition, however, was a common self‐management challenge for both medical and surgical patients. Several patients requested more information about their food and fluid intake, and many reported a decrease in appetite. The data from the message exchanges support this finding, demonstrating that the nutrition challenges were complex and frequently related to other factors, such as diarrhoea or constipation (i.e., patients with CRC) or fluid retention and dyspnoea (i.e., patients with HF). As a result, the nurse navigators needed to identify the source of the problem, provide individualised advice and work with the patients to set attainable goals. The importance of a mutual partnership between the nurse navigators and patients became especially clear when dealing with medication issues. Many patients had difficulty in understanding how to administer the medication, while others reported unpleasant side effects. In these cases, timely feedback from the nurse navigator and the ability to ‘stay ahead’ of the case proved particularly useful, as explained in an interview by this patient:

What bothered me the most was that I couldn't get rid of the dizziness, so I thought it would be best to contact the out‐patient clinic … but before I could do that the nurse contacted me because she saw I had been reporting dizziness. She discussed it with a supervising doctor and some of my medications were changed. That was really an improvement … a total change to my everyday life. I don't dare to run yet, but now I manage to get up. (Patient with HF 7)

5.2.2. Recognising a Need for Emotional Support

During the patient interviews, various emotional challenges were expressed. Many patients described negative thoughts about their reduced physical abilities, making them unable to participate in daily life activities. Furthermore, medications appeared seemed to add to patients' burden by being a steady reminder of having a long‐term illness. This patient said the following:

When I take the medication … that's when I feel sick … and I don't know what the future holds. Will I have shortness of breath every time I climb the stairs? Can't I do anything anymore? They told me I would ride a bike again … but what do they mean: an electric bike? (Patient with HF 16)

The transition from being healthy to being ill was difficult for many patients, and some had to redefine their sense of self and adjust their goals and expectations for the future. This required significant adaption and was characterised as difficult and overwhelming. Some patients were concerned about relapse, while others expressed a more overall sense of uncertainty about the future. Other patients reported ongoing pain and discomfort which affected their mood, sleep and overall quality of life. Furthermore, the extracted message exchanges confirmed the emotional burdens and challenges of living with a long‐term illness, with many patients alternating between hope and hopelessness. However, the nurse navigators were able to provide empathic support through the RPM intervention, which helped to alleviate the patients' emotional distress. In the exchanges, the nurse navigators appeared to gain a deeper sense of purpose. One of the nurse navigators said the following:

I talked to one patient via the video. The only thing he could think about was whether or not he needed additional chemotherapy. So, we talked for 20 min about that. Using 20 min listening to a patient's problem was better for him than any tranquilizer. (Nurse navigator 8)

5.3. Fostering a Continued Engagement in Health Behaviour Change

5.3.1. Strengthening Confidence to Manage Illness

This category focuses on how RPM improved patients' knowledge, which appeared to empower them, strengthen their confidence and motivation to take ownership of their illness and adhere to recommended lifestyle adjustments and treatment regimens more consistently. Moreover, consistent monitoring and feedback, together with positive reinforcement from the nurse navigators, appeared to establish a continuous learning process and enhance patients' belief in their ability to overcome challenges and adhere to recommended health behaviours in the longer term, as expressed in these patients' citations:

I have started exercising again … move around a bit more … and I understand more how everything is and how it's connected … I also became more conscious about what I ate … to eat more properly. (Patient with CRC 6)

I know a lot more about heart failure now compared to before. That's part of the follow‐up … and soon I'm going to this ‘heart school’ and I will start working out twice a week … this group thing for people with the same illness. (Patient with HF 8)

The nurse navigators' proactive approach to symptoms and measurements, as well as their prompt response to emerging issues, seemed to support patients' ongoing health behaviour change by minimising setbacks and optimising outcomes. Even during deteriorations, the nurse navigators upheld patients' trust by closely monitoring and managing their symptoms using the RPM intervention. As a result, a few patients were able to avoid rehospitalisation during the follow‐up period by collaborating with the nurse navigator to reverse the situation. The nurse navigators in many ways maximised the 30‐day follow‐up period by providing the patients with adequate tools to make them continue to do ‘good things for themselves’, as one of the nurse navigators phrased it. Another nurse navigator expressed the following:

The goal is to get them independent. So, even though they [the patients] would have liked to be followed‐up every day, they should after 30 days have received support and resources to manage on their own. (Nurse navigator 2)

5.3.2. Committing to Self‐Management

Regular check‐ins and remote consultations provided patients with ongoing support and encouragement to maintain positive health behaviours and adhere to care plans after hospital discharge. During the interviews, some of the patients stated that they had adapted to some of the activities that had become routine during the intervention. A few continued to measure their blood pressure, while others continued to weigh themselves. Other patients found the daily questionnaire to be ‘food for thought’ even after the intervention had ended, as stated by this patient:

I think back on the answers I provided every morning during my participation. I will continue to ask them to myself … and react to them … but I'm not sure I would have reacted to these things had I not participated. (Patient with CRC 1)

Some patients had already settled into positive lifestyle habits consistent with their illness before participating in the RPM intervention. However, some patients described that the digital follow‐up and regular measurements made them more receptive to the importance of adapting their activity level to their physical condition. The nurse navigators viewed RPM as a way to provide patients with regular care and feedback from the same healthcare professional over an extended period, making it easier for the patients to engage in self‐management activities.

5.4. Synthesising the Themes

The synthesised analysis identified one unifying key theme: Bridging technology and self‐management support through remote caring encounters. The unifying theme reflects the participants' experience of providing or receiving digital self‐management support through RPM. The term ‘caring encounter’ refers to the digital interaction between the carer (nurse) and the one being cared for (patient) (Locsin 2016), in which an attempt to initiate contact by one party triggered a response in the other. Patients' awareness of illness symptoms and their capacity for self‐management were strengthened through remote caring encounters with the nurse navigators. Additionally, the collaborative relationship between the patient and nurse navigator offered a structure for targeted, personalised care that facilitated clinical decision‐making. RPM also provided patients with a reliable point of human contact and the opportunity to regularly interact with nurse navigators, allowing for a continuous and emotionally supportive relationship that benefitted both the carer and the one being cared for. The unifying key theme with its three supporting themes is illustrated in Figure 3.

FIGURE 3.

Illustration of the unifying key theme with supporting themes.

6. Discussion

This study provides insight into patients with long‐term illness and nurse navigators' experiences with digital self‐management support after participating in a post‐hospital discharge RPM intervention. The main findings suggest that patients and nurse navigators' mutual digital engagement in the RPM intervention resulted in a better understanding of patients' symptoms and health behaviours, allowing them to support patients in their self‐management and patients to engage more effectively in self‐management activities. The abductive thematic analysis resulted in the construction of the unifying key theme of ‘bridging technology and self‐management support through remote caring encounters’, which firmly connected the themes and categories. To build on the foundations of abductive analysis and to better envision how TTCCN concepts were applied, the results of this study are discussed in relation to the three concurrently occurring events that comprise the process of knowing persons from TTCCN (i.e., technological knowing, mutual designing and participative engaging), as previously outlined in Figure 2.

In the current study, nursing was practiced entirely via digital technology. This required not only highly practical technical competence from the nurse navigators but also the ability to meet patient's complex medical healthcare needs in an empathic and caring manner through technology. In nursing, caring represents the very substantive focus of the discipline (Boykin 2001), and in the TTCCN, the relationship between nursing, caring and technology is central, with technological competency viewed and practiced as a form of caring. This study suggests that the RPM intervention acted as a bridge between the nurse navigators and the patients, creating ‘remote caring encounters’ that supported patients in their self‐management. Furthermore, as evident from the first theme ‘raising illness awareness through RPM technology’, patients gained insight into their illness by actively registering measurements and self‐reported symptoms, and they could initiate contact via the chat message service when necessary. Moreover, the RPM technology provided quick access to vital data and information, making it easier to engage in self‐management. Taking daily measurements, such as blood pressure, weight and temperature, registering daily forms and gradually learning to interpret and adapt to the data appeared to improve patients' self‐management behaviour, even beyond the 30‐day follow‐up period. For the nurse navigators, the RPM intervention enabled them to provide each patient with personalised and targeted self‐management support by skilfully leveraging the patients' daily measures and registrations across the 30‐day follow‐up period. This appears to be in line with the concept of technological knowing from the TTCCN, which is a way of knowing persons through the competent use of technologies. Healthcare technologies and being experts in technological advances are recognised as essential to the practice of nursing (Pepito, Locsin, and Constantino 2019). Moreover, advances in technology may bring the patient closer to the nurse by enhancing the nurse's ability to know more about the person, that is, the understanding of the patient is magnified by the reality of the data obtained from the technology (Krel et al. 2022).

The findings from this study suggest that an RPM intervention may enable two‐way communication between patient and nurse navigator, allowing them to exchange information. This is in line with a review that studied factors influencing the effectiveness of RPM interventions, which showed that both connection and communication between patients and HCP increased through RPM (Thomas et al. 2021). In the current study, the communication was mostly based on the patients' clinical measurements and registrations, and as the intervention progressed, both patients and nurse navigators improved their capacity to assess what was within the normal range for each patient. The repeated measurements, combined with back‐and‐forth communication with a nurse navigator, appeared to boost patients' confidence in accepting and understanding daily variances and fluctuations in their condition, as well as their self‐assurance in pushing themselves in their daily lives. This finding is supported by other research demonstrating that patients who have access to their health data become more educated about their disease (Korpershoek et al. 2018), exhibit better engagement in their health management (Subramanian et al. 2019; Turakhia et al. 2019) and perceive better control over their illness (Andersen et al. 2017; Korpershoek et al. 2018). In the current study, the nurse navigators became increasingly comfortable with the various fluctuations and changes in their patient's condition, making them more ‘relaxed’ knowing that what appeared to be severe was normal for that patient. Other studies have found that RPM allows clinicians to provide prompt care and that such digital solutions allow for a more realistic view of patients' vitals, including health trends and variations, resulting in more personalised and targeted care for each patient (Korpershoek et al. 2018; Maguire et al. 2020; Serrano et al. 2023).

Regarding self‐management, appropriate support from nurses is crucial (Chan et al. 2023), particularly in the period after hospital discharge (Facchinetti et al. 2020). Another important finding from this study, as is also evident from the second theme from the study, patients and nurse navigators collaborated to address patients' self‐management challenges. When patients' measurements and self‐reported symptoms revealed inconsistencies or deviations, the nurse navigators contacted them digitally. Patients were encouraged to contact the nurse navigator if they experienced any uncertainties about their measurements, their health behaviours or their condition. However, should they experience acute deterioration or complications, they were instructed to contact the emergency room. Nonetheless, the collaborative nurse–patient relationship in the current study appears to be consistent with the TTCCN's concept of mutual designing, which emphasises the valuing of patients as equal partners in their care rather than being objects of care (Pepito, Locsin, and Constantino 2019). An important principle in mutual designing is that the nurse and patient co‐create a mutually fulfilling nursing care process based on both the nurse's and the patient's needs (Locsin 2016). However, in accordance with the current standard of care when using RPM (Talbot et al. 2022), patients in this study were offered the responsibility of measuring their health data, reporting on their everyday condition and for contacting HCPs if they had any concerns. Thus, the interactions of the nurse navigators were directed and dependent on the behaviours and actions of the patients. Handing responsibility for health‐related chores over to patients, such as those associated with an RPM intervention, always raises the risk of overwhelming them with ‘duties’, potentially leaving them with an increased self‐management burden (Talbot et al. 2022). However, encouraging patients' autonomy and independence about their illness and self‐management is an important priority in modern healthcare—one that appears to be successfully supported in RPM (Talbot et al. 2022). Moreover, in line with the findings from this study, most patients possess the reasoning and intellectual capacity to contribute to their care (Locsin and Betriana 2024).

Research emphasises the importance of considering emotional factors when developing healthcare technologies (Andersen et al. 2017). The current study found that post‐hospital self‐management challenges for long‐term illness patients go beyond physiological measurements and symptoms. Some patients experienced fear and anxiety and sought emotional support. However, psychological difficulties and negative feelings may be challenging to address digitally because they are unique and situated (Andersen et al. 2017). The findings from this study, as well as previous ones, suggest that feedback on patients' self‐management efforts and proper communication from HCPs can help reduce some of the unpleasant sentiments that pervade many patients' lives. In contrast, a lack of feedback may cause anxiety and feelings of insecurity in patients (Andersen et al. 2017; Skov et al. 2015). The positive effects of having a nurse ‘on the other side’ in RPM interventions have been demonstrated in previous research (Pols and Moser 2009; Skov et al. 2015; Wathne et al. 2024). One study showed that ‘being seen’ by the healthcare service through a telehealth application contributed to a sense of security for patients, and the ability to interact regularly with the same HCP was perceived as safe care (Ekstedt et al. 2023). Furthermore, the authors presenting the current study have previously shown that the social relationship and digital interaction between patients and nurse navigators were the driving force of an RPM intervention, as well as a precondition for the participant's willingness to accept and use it (Wathne et al. 2024). Thus, what appears to be ‘cold’ monitoring technologies may become ‘warm’ when patients learn how to use them to communicate and interact with nurses and other HCPs (Andersen et al. 2017; Pols and Moser 2009).

A cornerstone of the TTCCN is to utilise technology to improve the caring relationship between nurses and patients (Locsin 2016). TTCCN posits that technological competence and nursing care are not opposing forces, but rather coexists harmoniously. According to the theory, technology supports the nursing process by enabling a deeper and more prompt knowledge of patients, allowing nurses to provide more comprehensive and personalised care (Barchielli et al. 2021). Furthermore, the phrase participative engaging refers to the simultaneous practice of shared activities. Thus, taking the perspective of the TTCCN on RPM, participative engaging entails using technology to encourage patients to take an active role in their healthcare with the assistance of HCPs (e.g., nurse navigators) who use technology to provide necessary information and options. A notable finding from the current study, which is also expressed in the third theme, was that participation in the RPM intervention fostered a more sustained health behaviour change in some of the patients. The reciprocal relationship between them and the nurse navigators appeared to strengthen their confidence in making informed health decisions, as well as provide them with new options for illness prevention, early detection of illness deterioration and increased commitment to self‐management of their long‐term illness. Although the nurse navigator follow‐up was based on the patients' daily measurements and registrations, it was not a ‘one‐size‐fits‐all’ activity. They frequently had to communicate with the patients, mainly through the chat function, to reach an agreement on the self‐management challenges and which measures to implement. However, the RPM intervention appeared to put the patient at the centre of care while also allowing nurses to perform their work efficiently and safely (Pepito, Locsin, and Constantino 2019).

6.1. Strengths and Limitations

This study has several strengths. First, it included both end users of an RPM intervention. Second, it applied the theoretical perspective of the TTCCN in a novel way. Although the theory had not previously been applied in an RPM‐enabled setting, it proved valuable in offering insight into the digital patient–nurse–navigator relationship, thereby broadening its application. Furthermore, nurses appear to play an important part in the digital transformation of our healthcare system, and theories such as the TTCCN can help integrate digital technology while retaining a caring nursing practice.

The qualitative multimethod research approach employed in this study provided diverse and extensive research findings, resulting in a unifying key theme that offered new theoretical and practical insight into RPM and post‐hospital self‐management support from patients and nurse navigators perspectives. However, the study had some limitations. First, the greater number of patient participants compared to nurse navigators may have resulted in a different representation of patient versus provider perspectives. Furthermore, the different interviewing modes (i.e., face‐to‐face vs. digital and individual vs. dyadic interviews) may have resulted in dissimilar dynamics during the interviews, potentially affecting the findings.

6.2. Recommendations for Practice

The results from this study are important as they demonstrate that RPM technology may increase patients' confidence and engagement in their health management in the period following hospital discharge. However, for RPM to be widely used, interventions must include components appropriate to each patient target group. The inclusion of nurses in RPM solutions is also crucial for prompt nursing care and secure self‐management support. This includes providing nurses with the necessary training to strengthen their technological competence as well as the clinical competency required to meet the self‐management needs of varied patient populations. Furthermore, to achieve positive results when employing RPM, it may be necessary to transition to a model of care as outlined in the TTCCN, rather than simply implementing technology that is not theory‐based.

6.3. Recommendations for Future Research

First, more studies is needed on the interactional and collaborative relationships between patients and HCPs in RPMs, particularly quantitative longitudinal studies that investigates how the patient–provider relationship evolves. Second, examining the long‐term effects of RPM interventions on patients' health outcomes and quality of life appears to be as important. Third, research on how RPM benefits intervention providers and improves their ability to provide self‐management support to patients with long‐term illnesses following hospital discharge could be beneficial. However, such studies should also include findings on how RPM affects HCP workflow and how to integrate RPM into existing healthcare systems. Last, research on different patient populations is crucial for establishing holistic and effective healthcare practices that improve patient care and outcomes on a broader scale.

7. Conclusion

The current study suggests that the digital caring encounters between patients and nurse navigators were mutually beneficial as they improved patients' daily self‐management routines and nurse navigators' decision‐making processes. In line with important concepts of the TTCCN, RPM promoted a caring nursing practice in which the patients were understood and viewed as equal partners in their care rather than simply objects of care (Nakano et al. 2021). By allowing patients' understanding to be magnified through the realities of the data obtained from the technology (i.e., technological knowing), by co‐creating the care together with the patients (i.e., mutual designing) and by entering the world of the patients, interacting with them in an alternating rhythm of learning and evaluating (i.e., participative engaging), the nurse navigators supported patients in their self‐management. In conclusion, RPM appears to prioritise the healthcare needs recognised by patients over those identified by nurses. Thus, RPM has the potential to become a vital tool in modern‐day healthcare, allowing for more patient‐centred and patient‐strengthening care.

Author Contributions

The first author is the lead author, responsible for data collection and analysis, as well as drafting the manuscript. However, all four authors contributed to interpret and analyse the data, read drafts and approved the final version of this manuscripts and its revision.

Conflicts of Interest

The authors declare no conflicts of interest.

Peer Review

The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer‐review/10.1111/jan.16736.

Supporting information

Data S1.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon request. The data are not publicly available due to privacy or ethical restrictions.