by Ronald Jayson E. Torres, MAN, RN
Institute of Health Sciences and Nursing,
Far Eastern University, Philippines

Citation: Torres, T. J. E. (2025). Telehealth self-confidence and readiness for practice among medical-surgical nurses in selected hospitals in metro Manila. Canadian Journal of Nursing Informatics, 20(4). https://cjni.net/journal/?p=15678

Abstract

Introduction: With the growing integration of digital technologies in healthcare, telehealth has become a vital aspect of nursing practice, especially in the post-pandemic era. For medical-surgical nurses, self-confidence in telehealth delivery and readiness for practice are essential in ensuring safe, efficient, and patient-centered care. However, limited studies have explored these constructs within the Philippine context.

Methods: This study assessed the level of telehealth self-confidence and readiness for practice among medical-surgical nurses in selected hospitals in Metro Manila and examined their relationship with telehealth competency. A total of 217 nurses from public and private hospitals in Metro Manila participated. The Hospital Nurses’ Self-Reported Confidence in Their Telehealth Knowledge, Skills, and Attitudes and the Telehealth Readiness Assessment Tool were utilized. Results showed that nurses reported good telehealth self-confidence and high readiness for practice.

Results: Among the self-confidence domains, attitude ranked highest, while operations and staff engagement were most pronounced in readiness. Significant correlations were found between telehealth self-confidence and readiness for practice, notably in knowledge (rs = 0.336, p < .001) and skills (rs = 0.220, p < .001). Significant differences in readiness were also noted across age groups (H = 18.2, p = 0.001), year of graduation (H = 32.0, p = 0.001), and work setting (H = 9.41, p = 0.009).

Discussion: These findings highlight the importance of increasing nurses’ exposure to telehealth technologies through structured and competency-based training programs. Enhancing institutional support and providing continuous professional development opportunities are vital to strengthening telehealth self-confidence and readiness for practice. Such initiatives can foster greater technological proficiency among nurses and support the seamless integration of telehealth into routine clinical workflows, ultimately contributing to improved patient care delivery.

Keywords: Telehealth Self-Confidence, Readiness for Practice, Medical-Surgical Nurses, Digital Health, Metro Manila

Introduction

Telehealth, broadly defined as the delivery of healthcare services via electronic communication technologies, has emerged as a transformative tool for increasing healthcare accessibility, improving outcomes, and reducing costs (Tuckson et al., 2017; Fabian et al., 2024). It includes modalities such as videoconferencing, mobile health apps, and electronic records that facilitate remote patient-provider interaction (Alenoghena et al., 2023). Despite its promise, telehealth adoption in developing countries like the Philippines has been challenged by infrastructure limitations, technological barriers, and low provider confidence (Brewster et al., 2014; Kripalani et al., 2014).

The COVID-19 pandemic significantly accelerated telehealth adoption in the Philippines, prompting widespread use of platforms such as KonsultaMD and Medgate. Reports show teleconsultations surged from fewer than five sessions monthly in 2019 to nearly 500 in 2022 (Aban et al., 2024), reflecting increased public acceptance of remote healthcare. A mixed-methods study by Floresca et al. (2021) found Filipino nurses generally accepted telehealth systems, with demographic variables such as age and experience influencing system usability.

However, regional disparities persist. While Metro Manila has made substantial progress in telehealth integration, rural areas continue to face challenges in connectivity and digital literacy. Within this landscape, medical-surgical nurses tasked with coordinating virtual care and educating patients play a central role in telehealth delivery. Their effectiveness is closely linked to their self-confidence in using telehealth technologies and their readiness for digital practice (van Houwelingen et al., 2018).

Self-confidence in telehealth involves perceived competence in tasks like virtual assessments and troubleshooting, while readiness includes both clinical and technical preparedness. A lack in either area may hinder successful implementation. Studies suggest that higher self-efficacy promotes better technology adoption (Bandura, 1977; Hassan et al., 2020), making these traits especially vital in resource-limited settings.

While international literature has outlined essential telehealth competencies for nurses, local data remain limited. To address this gap, this study investigates the relationship between telehealth self-confidence and readiness for practice among medical-surgical nurses in Metro Manila. Guided by Peplau’s Interpersonal Relations Theory, Bandura’s Self-Efficacy Theory, and Armenakis et al.’s Readiness for Change Framework, the research aims to identify key influences on telehealth adoption and inform future interventions, training, and policy development in the Philippine healthcare system.

Operational Definitions

Medical-Surgical Nurses

Medical-surgical nurses are essential in the perioperative process, ensuring comprehensive care for patients before, during, and after surgery (Nazon et al., 2022). They are registered nurses who specialize in the care of adult patients with a wide range of medical conditions or those recovering from surgery. According to the Academy of Medical-Surgical Nurses (AMSN) in 2021, medical-surgical nurses work in various clinical settings, including hospitals, surgical units, and outpatient facilities, where they are responsible for conducting comprehensive assessments, monitoring patient conditions, and managing medical and surgical interventions. Their duties include administering medications, observing and documenting vital signs, assisting with diagnostic and therapeutic procedures, and providing patient education. In collaboration with interdisciplinary healthcare teams, medical-surgical nurses contribute to the development and implementation of individualized care plans, ensuring the delivery of safe, effective, and evidence-based nursing care. They play a key role throughout the perioperative continuum, including pre-operative and post-operative phases, ensuring optimal patient outcomes. In this study, medical-surgical nurses refers to nurses who have earned a Bachelor of Science in Nursing degree in the Philippines, passed the Philippine Nurse Licensure Examination, licensed by the Professional Regulation Commission (PRC), and employed as full-time medical-surgical staff nurses in selected hospitals in Metro Manila. Further, these are nurses who render care for clients with acute or chronic problems in oxygenation, fluid and electrolytes, infectious, inflammatory and immunologic response, cellular aberration, nutrition, and GI metabolism and endocrine, perception and coordination.

Telehealth

According to Kripalani et al. (2014), telehealth services are an integral approach and future focus for hospitals to, for instance, lower hospital readmission rates. According to Brewster et al. (2014), telehealth is the practice of delivering medical care remotely via digital tools like videoconferencing rather than in person. In this study, telehealth refers to the use of nursing or health informatics, electronic medical records (EMR), electronic health records (EHR), telemedicine, Integrated Hospital Information Management System (iHIMS), Integrated Hospital Opera-tions and Management Information System (iHOMIS), computerized physician order entry (CPOE), and e-prescriptions.

Methods

Research Design

This study employed a quantitative descriptive correlational design to examine telehealth self-confidence and readiness for practice among Medical-Surgical Nurses in selected hospitals in Metro Manila, Philippines. The non-experimental design allowed observation of natural relationships between variables without manipulation, focusing on describing current levels and exploring associations.

Research Locale

Data were collected from two purposively selected Level 3 hospitals in Metro Ma-nila: a private tertiary hospital in Mandaluyong City with comprehensive digital health services, and a specialized oncology hospital in Taguig City with advanced telehealth infrastructure. These settings were chosen due to their active integra-tion of telehealth technologies and relevance to medical-surgical nursing practice.

Population and Sample

The study population consisted of 217 full-time Medical-Surgical Nurses employed in these hospitals. Participants were purposively sampled based on specific inclusion criteria: licensed nurses who graduated from a CHED-recognized institution between 2012 and 2024, currently working in medical-surgical units, and regularly involved in telehealth activities. Nurses in managerial or part-time roles, on extended leave, or with limited telehealth exposure were excluded. Sample size was determined using G*Power software, with a target of at least 210 participants to ensure sufficient statistical power.

Research Instrument

Two validated instruments were used for data collection: the Hospital Nurses’ Self-Reported Confidence in Telehealth Knowledge, Skills, and Attitudes scale, consisting of 31 items rated on a 5-point Likert scale, and the Telehealth Readiness Assessment Tool (TRAT), a 17-item instrument assessing readiness across multiple domains, also rated on a 5-point Likert scale. Permissions to use these tools were obtained from the original authors (van Houwelingen et al., 2019; Maryland Health care Commission, 2019).

Data Collection Procedure

After securing ethical approval and hospital permissions, eligible nurses were invited to participate and completed self-administered questionnaires either in pa-per or electronic form. Participants were informed of the study’s purpose, confidentiality, and voluntary nature. Completed questionnaires were reviewed for completeness prior to analysis.

Statistical Analysis of Data

Descriptive statistics such as frequencies, percentages, means, and medians were used to summarize demographic data and instrument scores. Normality tests guided the choice of measures for central tendency. Inferential statistics, including correlation analyses, assessed relationships between telehealth self-confidence and readiness. Statistical significance was set at p < 0.05.

Results

The demographics analysis revealed that the majority of the 217 medical-surgical nurse respondents were female (70.0%), aged 40 and below (97.7%), and predominantly worked in inpatient settings (67.3%). Most had over one year of telehealth experience (71.9%) and were either recent graduates (2019 onward) or had graduated in 2014 or earlier. Medical-surgical nurses are digitally engaged as shown by high daily use of digital tools.

Medical-surgical nurses demonstrated good self-confidence across the thirty-one items covering telehealth knowledge (mean = 4.22), skills (mean = 4.10), and attitudes (mean = 4.25) (see Tables 1, 2, and 3). However, common areas of concern clustered around technical challenges, including handling technical difficulties, checking equipment functionality, teaching patients how to use equipment, and building confidence in using technology.

Table 1

Level of Telehealth Self-Confidence of Medical-Surgical Nurses in terms of Knowledge

Table 2

 Level of Telehealth Self-Confidence of Medical-Surgical Nurses in terms of Skills

Table 3

 Level of Telehealth Self-Confidence of Medical-Surgical Nurses in terms of Attitude

Using the same qualitative descriptor for the overall TRAT results, all five dimensions, including core readiness, financial considerations, operations, staff engagement, and patient readiness, demonstrated high readiness. It follows, therefore, that the medical-surgical nurses are highly ready (mean = 80.1%) to practice telehealth. Specifically, most MS nurses (61.3%) demonstrated high readiness for telehealth, 35.0% showed moderate readiness, and only 3.7% were classified as having low readiness (Table 4).

Table 4

Level of Telehealth Readiness for Practice of MS Nurses (Summary)

Medical-surgical nurses’ self-confidence in telehealth knowledge, skills, and attitudes is consistent across all demographic groups, indicating that their confidence remains steady regardless of their profile characteristics (Table 5). However, telehealth readiness is influenced by certain factors, with higher readiness levels observed among middle-aged MS nurses, those who graduated in 2015 or earlier, and those working in outpatient settings (Table 6).

Table 5

Significant Difference in the Level of Telehealth Self-Confidence when Grouped According to Profile

Table 6

Significant Difference in the Level of Telehealth Readiness when Grouped According to Profile

Medical-surgical nurses’ self-confidence in telehealth knowledge, skills, and atti-tudes does not correlate well with their overall telehealth readiness. Other factors may be influencing their preparedness to practice telehealth (Table 7).

Table 7

Significant Relationship between the Level of Telehealth Self-Confidence and Readiness for Practice of MS Nurses

Discussion

This study explored the telehealth self-confidence and readiness for practice among Medical-Surgical Nurses in selected Metro Manila hospitals. The findings highlighted important insights into how nurses perceive their abilities and preparedness to integrate telehealth into their clinical roles.

The moderate to high levels of self-confidence reported by nurses suggest that many are comfortable with their knowledge, skills, and attitudes toward telehealth. This may reflect the growing incorporation of digital health education in nursing curricula and ongoing exposure to telehealth technologies in clinical settings. However, areas of lower confidence identified indicate a need for targeted training, particularly in complex telehealth competencies and technology use. Strengthening these areas could enhance nurses’ overall efficacy and willingness to adopt telehealth practices.

Readiness scores demonstrated variability, which underscores the multifaceted nature of telehealth adoption. Factors such as organizational support, leadership engagement, and availability of resources appear critical in shaping nurses’ readiness. The significant correlation between self-confidence and readiness implies that improving nurses’ telehealth competencies could positively influence their acceptance and effective use of telehealth services. This aligns with existing literature emphasizing that confidence and preparedness are key facilitators in the adoption of new healthcare technologies.

The selection of hospitals with advanced digital health systems provided a valuable context to observe telehealth integration in real-world settings. Nevertheless, readiness may differ in less technologically equipped environments, suggesting a need for broader studies across diverse healthcare facilities.

Overall, the findings emphasized the importance of continuous professional development and institutional strategies that support telehealth education and infrastructure. Tailored interventions to build both individual competencies and organizational capacity will be vital in sustaining telehealth implementation and improving patient care outcomes.

Future research could explore longitudinal impacts of telehealth training programs and investigate barriers faced by nurses in different clinical settings. Additionally, qualitative studies may provide deeper insights into nurses’ experiences and attitudes towards telehealth, enriching the understanding gained from quantitative assessments.

Conclusions

The integration of telehealth into healthcare has accelerated, especially during the COVID-19 pandemic, reshaping nursing practice. Medical-surgical nurses now re-quire not only clinical expertise but also digital competence. In the Philippines, telehealth adoption has increased, yet structured training and institutional sup-port often lag behind, raising concerns about nurses’ confidence and readiness.

This study examined telehealth self-confidence and readiness for practice among 217 medical-surgical nurses in Metro Manila. Most respondents were female, under 40, and had more than one year of telehealth experience. Results showed high self-confidence in telehealth-related knowledge, skills, and attitudes, likely due to increased digital exposure. However, nurses still face difficulties with technical aspects such as troubleshooting and patient instruction, suggesting gaps in practical skills.

Readiness was also high across five domains: core, financial, operational, staff, and patient readiness. Higher readiness was linked to older age, earlier graduation, and outpatient work settings. Despite these positive findings, the study found only a weak correlation between self-confidence and readiness. This suggests that confidence alone does not ensure preparedness, as systemic factors such as infrastructure and support also play key roles.

These results highlight the need for targeted training, better protocols, and institutional support. Future research should include diverse settings and explore organizational influences. Strengthening both individual competencies and system-level readiness is essential for effective and equitable telehealth delivery.

Conflict of Interest

The author declares no conflict of interest regarding the publication of this paper.

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