Table 3 Summary of main CMOCs presented in the paper

Faster response supports uptake

Quick access to services

Staff observe that fastest response

Perceived benefit in speed means it’s more likely to be used again

More experience of rapid access will increase use, and becoming part of routine care

Unequal relationships hinder use

Opportunity to reduce professional isolation

Where staff consider themselves equal partners, videoconferencing may reduce professional isolation

However if staff feel inferior, and the staff are qualified nurses, they may be less likely to use the service

When staff consider themselves equal partners, videoconferencing will tend to be used sooner for advice

Videoconferencing is more likely to be used when staff feel equal and feel the need to seek support. Increasing the uptake and sustainability

Team stability & support encourages psychological safety and innovation

Provides a new and innovative way of delivering healthcare

Where staff feel unsure of how to meet a resident's needs, they may seek support from a member of staff with more experience. Where there is strong team stability, members are likely to have increased psychological safety

Here, it is more likely that the staff member will seek support before using the service. As their self-efficacy grows, it will become less daunting, and staff may begin to use the system independently

Increased self-efficacy will help to overcome obstacles and reaffirm commitment to videoconferencing. Which will make videoconferencing more sustainable

Low confidence hinders uptake

Opportunity for junior staff members to consult with a remote nurse

Where staff have less experience in managing residents’ health, they may be less confident in using videoconferencing

Less experienced staff will be more likely to access the service with the support of someone that is more experienced / in a more senior post

An adequate ratio of senior to junior employees and a culture of supporting junior staff will increase the uptake and sustainability of videoconferencing

Opinion leader advocacy supports uptake

a new method of healthcare delivery

There is a pre-existing homogenous environment, which supports the exchange of opinions

Staff act as informal / formal opinion leaders, sharing their view of the system. It is more likely that the impact of advocacy amongst the team will be increased

More staff will trial the system and develop their self-efficacy. Depending on their experiences, this may increase uptake and sustainability