Understanding Risks to Patient Safety from the Perspective of Nurse Practitioners Delivering Primary Health Care Using Telemedicine

Abstract Background. Advances in information technology have expanded the availability and quality of virtual health care (VHC), with the COVID-19 pandemic accelerating telemedicine use. Telemedicine improved access, affordability, and safety by supporting physical distancing. However, the rapid shift from in-person care also introduced new patient safety risks. Nurse practitioners in primary health care (NP-PHCs), who provide comprehensive care across the lifespan, are well positioned to advance safety and quality in telemedicine. Despite this, little research has explored NP-PHCs’ perceptions and experiences of patient safety risks in this context. Purpose. This dissertation aimed to examine risks to patient safety in the delivery of primary health care through telemedicine. Methods. A multiphase design was used, including (1) a scoping review of literature on telemedicine-related patient safety risks and (2) a qualitative study informed by critical hermeneutics to explore NP-PHCs’ experiences and perceptions. Results. The scoping review (22 studies) identified both safety benefits and barriers associated with telemedicine. In the qualitative phase, nine NP-PHCs from diverse practice settings across Ontario were interviewed. Analysis emphasized meaning, context, and power. Four themes emerged: (1) “It opened a door”—telemedicine improved access for some (e.g., rural residents, working parents) while excluding others (e.g., older adults, non-English speakers, uninsured individuals); (2) “Training? None!”—participants reported limited preparation for safe telemedicine practice; (3) “You’re working against the system”—fragmented systems, unclear referral pathways, and heavy documentation burden hindered safe care; and (4) “It was draining”—emotional exhaustion, moral distress, and unrecognized cognitive labour affected clinicians’ capacity to deliver safe care. Conclusion. This study enhances understanding of factors shaping safe telemedicine delivery in Ontario and addresses a gap in research on NP-PHC experiences. Using an expanded view of safety, the findings inform recommendations for policy, education, practice, and research. Conducted in response to the pandemic-driven shift to telemedicine, this work highlights the need for improved preparedness and risk mitigation in future transitions to virtual care. Keywords: critical hermeneutics, nurse practitioners, patient safety, primary health care, telemedicine

Department dc:contributor.department

Nursing

Year dc:date.issued

2026

Author dc:creator

• Craddock, Elena

Advisor dc:contributor.supervisor

• Godfrey , Christina

• critical hermeneutics
• nurse practitioners
• patient safety
• primary health care
• telemedicine
• scoping review

Language dc:language.iso

eng

Handle dc:identifier.uri

https://hdl.handle.net/1974/36372

OAI identifier oai:identifier

oai:queensu.scholaris.ca:1974/36372