A qualitative study was conducted with data collected through semistructured interviews with nurses between May and September 2023. This approach was chosen for its effectiveness in capturing the complex, context-specific, and emotional experiences inherent to nurses’ roles in a new care model—areas difficult to explore through quantitative methods [23]. This study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines to ensure transparency and rigor in reporting [24]. A completed 32-item COREQ checklist mapping to the manuscript content is provided as Checklist 1.

Purposive sampling was used to recruit nurses who had experience delivering the Internet+Nursing Service. Eligible participants were those who had provided care to patients with dysphagia for a cumulative duration of more than 6 months. To enhance the diversity of the sample, participants were selected based on variation in service items (eg, nasogastric tube placement, feeding guidance, rehabilitation training, and nutritional monitoring), duration, gender, and geographic location. Participants were recruited from 4 regions—Beijing, Guangdong, Zhejiang, and Jiangsu—where the service was first piloted and has since been widely implemented. Participants were contacted via WeChat through hospital administrators. The researcher introduced the purpose and content of the study and provided detailed information to ensure participants’ full understanding. They were informed that participation was voluntary and that they could decline or withdraw at any time without any consequences. Informed consent was obtained prior to scheduling the interview.

Based on the research purpose and a review of relevant literature, the interview guide was developed under the guidance of a nursing professor (QX). To provide further clarity, exploratory questions were added to the main interview questions to better capture the depth and complexity of participants’ experiences, as shown in Table 1.

All participants were interviewed alone by the first author, a female PhD candidate with formal training in qualitative research, through Tencent Meeting, a secure digital conferencing platform. Given her familiarity with the topic, she consciously minimized potential bias by adhering closely to the interview guide and maintaining a neutral stance throughout data collection.

The first interview was conducted with a Chief Nurse who had extensive frontline experience in delivering the Internet+Nursing Service to patients with dysphagia. Her insights into practical challenges and strategies helped refine the focus of subsequent interviews. Interviews were video recorded, but for participants who declined to use their cameras due to privacy concerns, only audio was recorded. The interviews were conducted under private and secure conditions to ensure confidentiality and comfort for the participants. Most participants joined from their homes, a setting that was perceived as comfortable and conducive to open discussion. When participants mentioned their experiences and perceptions about service, the researcher encouraged them to elaborate and provide specific examples. Field notes were taken during the interviews to capture key observations such as participants’ tone, pauses, and non-verbal cues. These notes provided additional contextual insights to complement the interview transcripts, helping to enhance data interpretation. Each participant was interviewed once; no repeat interviews were conducted.

Data saturation was reached after interviewing the 16th nurse, and 2 additional interviews were conducted to confirm saturation and ensure data robustness. All 18 invited nurses agreed to participate, and none withdrew from the study. The average interview duration was 41.2 (range 38.5‐45.3) minutes.

All interviews were transcribed verbatim within 24 hours and analyzed concurrently with data collection. The transcripts were reviewed for consistency and returned to participants for member checking. Although no revisions were made, this step helped ensure accuracy and credibility. Data were analyzed using conventional content analysis, a method suitable for areas with limited theoretical and empirical foundations—such as nurses’ experiences in providing the Internet+Nursing Service for patients with dysphagia [25]. This approach allows categories to emerge inductively from the data, enabling a nuanced understanding grounded in participants’ perspectives without imposing preconceived frameworks [23,24,26].

Two authors (ZR and LT) independently conducted the initial data analysis. They first read the transcripts to become familiar with the content, then separately identified significant statements and conducted open coding. This process yielded 203 initial codes, reflecting the depth and diversity of the participants’ responses. Similar codes were grouped into categories and subcategories. Some codes specific to dysphagia-related experiences were incorporated into broader thematic structures to ensure conceptual coherence. When a disagreement arose between the 2 analysts, 2 experts in qualitative nursing research (QX and YW) were asked to arbitrate in order to ensure the scientific validity of the coding. Finally, themes and subthemes were developed based on the categories and subcategories[27]. Data coding and analysis were conducted manually. All interviews were carried out and analyzed in Chinese. Results were subsequently translated into English. The translation was reviewed by bilingual researchers to preserve the original meaning and contextual accuracy. While transcripts were returned to participants for accuracy checking, the findings were not returned for feedback.

This study was approved by the Medical Ethics Committee of the Capital Medical University (approval no. Z2022SY029). Although participants’ identities were known to the researcher during data collection, all data were deidentified prior to analysis by assigning unique identification codes. Informed consent was obtained from all participants, who were informed that their participation was voluntary and that they could withdraw from the study at any time without any consequences. Participants received a compensation of approximately US$30 in recognition of their time and contribution.

In total, 18 nurses participated in this study, identified by codes N1-N18. In total, 17 (94.4%) were female and 1 (5.6%) was male. Participants’ ages ranged from 32 to 51 years, with a mean of 38.8 (SD 5.9) years and a median of 37.5 years(IQR: 33.0–44.3). More than half of the participants held the professional title of nurse practitioner-in-charge. All participants had attained an undergraduate degree. The duration of service involvement (in months) ranged from 6 to 60, with a mean of 30.1 (SD 14.6) months and a median of 25.0 months (IQR: 18.0–43.5), as shown in Table 2.

A total of 3 main themes and 9 subthemes were identified through data analysis. The overall coding framework, including the hierarchical relationship between themes and subthemes, is presented in Figure 1. Participant quotations were used to support each theme, ensuring consistency between the raw data and the analytical findings.

This qualitative study identified 3 key themes: value representation and social impact, nursing resources and staffing, and safety and management support. The findings suggest that nurses perceive their participation in the Internet+Nursing Service as a means of affirming their professional value; however, they face constraints related to time and energy. Additionally, concerns regarding nurse safety and potential nurse-patient disputes emerged as significant issues. Future efforts should focus on safeguarding nurses’ rights, addressing their concerns, and fostering the sustainable development of these services.

In terms of value realization, nurses believed that the Internet+Nursing Service could provide patient-centered health services. Its implementation involves safety considerations that are distinct from in-hospital settings. Since nurses assume full responsibility for out-of-hospital care, patient safety became a central focus in their assessments [28]. Specifically, they assessed whether the patient’s underlying condition was suitable for home-based care, as well as potential emergency scenarios [29]. This safety-first approach aligns with evidence from international home health care contexts, where studies from Saudi Arabia highlight nurses’ strong competencies in creating safe environments for elderly care [30], and Iranian research emphasizes continuous risk assessment as fundamental to safe home health care delivery [28]. Nurses observed that patients who required regular gastric tube replacements often forgot their scheduled appointments. Creating a health record with automated reminders could help patients manage their gastric tube changes more effectively. Digital health interventions, such as short message reminders, have demonstrated significant potential in improving patient adherence to scheduled health care activities and associated health outcomes. This finding aligns with Tesfahun et al [31], who emphasized the role of short messages in enhancing health service utilization and outcomes. Furthermore, nurses noted that patients were often not fully prepared to manage their condition before discharge, and caregivers often lacked appropriate caregiving knowledge. This preparation gap has significant clinical implications, as studies have shown that 90% of patients were discharged with at least 1 unresolved health care issue [32], and being unready for discharge increased the risk of 30day unplanned readmission and mortality [33]. The Internet+Nursing Service can address this deficiency. After living at home for a period, patients can consult one-on-one with the nurse about problems they have not mastered, and nurses found that the effect of health education and guidance is better than in the hospital. Evidence from Israel’s Community-Based Home Hospitalization model confirms the advantages of community-based follow-up, demonstrating reduced hospital readmission rates, lower daily health care costs, and shorter lengths of stay compared to conventional inpatient care [34]. Moreover, when nurses enter the patients’ homes and learn about their economic and social environment, they can better understand the emotions or decisions of patients and their families. This improved understanding helps nurses empathize with the families and may reduce conflicts between nurses and patients. Empathy is widely recognized as a key element of home care services and is strongly associated with care satisfaction for both providers and recipients [35]. In Australian home care, stakeholders emphasized the importance of empathy and person-centered relationships for high-quality, individualized care [35]. These findings suggest that the Internet+Nursing Service improves care delivery and strengthens nurse-patient relationships, thereby promoting more holistic and person-centered care in community settings.

Nurses believed that providing the Internet+Nursing Service enhanced their sense of professional fulfillment. In traditional clinical settings, nurses primarily followed medical directives passively, lacking autonomy and experiencing low professional satisfaction. Consistent with previous studies, limited autonomy has been identified as a risk factor for nurse burnout [36]. In contrast, home-based services offered a stronger sense of achievement, as nurses received both patient gratitude and monetary recognition for their professional skills. This aligns with findings that highlight salary as a key contributor to nurses’ professional fulfillment [37]. Moreover, the home environment provided a new operational space compared to hospitals, allowing nurses to broaden their practice and apply their scientific skills, such as developing patents. This is crucial for advancing nurses’ professional growth [38]. Caring for patients with dysphagia involves considerable uncertainty, and caregivers often seek hospital confirmation due to concerns, straining health care resources. Providing targeted guidance on caregiving practices can help caregivers alleviate this burden and reduce unnecessary reliance on institutional care. Prior studies have demonstrated that transitional care interventions from hospital to community play a critical role in reducing readmission rates and emergency department visits [39]. Such transitional care support not only mitigates system-level pressures but also strengthens family caregiving capacity, thereby disrupting the discharge-readmission cycle. The urgent demand for services from patients and their families, along with the personal value expression of nurses, are positive influencing factors for nurses participating in the Internet+Nursing Service.

The shortage of nurses has long been a concern for health care delivery systems worldwide [40,41]. According to the World Health Organization (WHO) report, the global shortage of nurses based on population health needs is projected to reach 5.7 million by 2030 [42]. The Internet+Nursing Service model is no exception, facing similar human resource challenges. Nurses reported experiencing high levels of stress due to demanding work schedules and limited personal time. They often prioritize rest and family time, which reduces their motivation to accept assignments, consistent with findings from previous studies [43]. Nurses in this study expressed dissatisfaction with their salaries, citing a perceived misalignment between their compensation and the overall cost of service provision—a finding consistent with previous research [42,44]. Nurses noted that the time spent on home-based services, commuting, health education, and rehabilitation instruction exceeds that of equivalent tasks performed in hospitals. This mismatch between effort expended and remuneration received diminishes their motivation to accept assignments [45]. Furthermore, nurses highlighted in interviews that while many join the Internet+Nursing Service System, only a small fraction actively accept assignments. This suggests that the service’s full potential has yet to be realized. The reluctance of some nurses to take assignments increases the workload for those who do, increasing service burden and exacerbating human resource challenges within the Internet+Nursing Service. In contrast, Australia’s home-based nursing services are primarily provided by full-time hospital-assigned teams composed of experienced nurses. In comparison, China’s model depends on nurses volunteering during their off-duty hours, which may limit the consistency and sustainability of service delivery [46]. Currently, management responsibilities related to the Internet+Nursing Service are often delegated to managers who have other duties, which hinders effective patient demand assessment and service quality control. To address these issues, medical institutions and platforms must enhance collaboration, establish robust operational systems, cultivate a larger pool of service-oriented professionals, and improve practices related to recruitment, training, assignment dispatch, and quality assurance. Despite the ongoing challenges in the service process, participants remain committed to providing care because they recognize the significance of their work for both patients and caregivers.

Nurses consistently voiced concerns about safety, particularly personal safety, which aligns with previous findings [37]. Although the Internet+Nursing Service offers security measures, nurses reported ongoing uncertainty about emergency response protocols. In addition, nurses are solely responsible for assessing and documenting dysphagia patients, which raises concerns about the reliability and accountability of clinical records. Nurses emphasized the importance of sharing experiences through regular peer communication and expressed a strong desire to establish direct contact channels with service platforms [47]. Such channels would enable them to propose suggestions and contribute to service improvement effectively.

Nurses involved in the Internet+Nursing Service express concerns about potential medical disputes stemming from errors, which could negatively impact their routine hospital responsibilities [46,47]. Consequently, nurses seek support from hospitals, including both organizational and telematic support. Organizational support is crucial in how individuals perceive management’s attention and care, while telematic support ensures timely access to information and medical resources, such as health care teamwork [48,49].

In the future, it will be essential to implement robust safety protocols—such as establishing standardized response times for emergency services (eg, police arrival times after alarm activation) and developing clear guidelines for insurance coverage (eg, compensation details and claim processing timelines)—to effectively address nurses’ concerns regarding safety and support. Moreover, establishing multifaceted communication platforms—such as professional conferences, web-based forums, and community media engagements—will be essential for fostering experience sharing among nurses and amplifying awareness of successful cases. This, in turn, will enhance their confidence in delivering services.

Research indicates that health care collaboration and organizational support are critical drivers for improving nursing service quality [50,51]. In this context, the creation of a web-based medical expert network could empower nurses by providing access to remote doctor consultations and real-time guidance during emergencies or complex clinical situations. Future policy making and management efforts should focus on safeguarding nurses’ rights, addressing their concerns, and optimizing their working conditions. Accelerating the development of the Internet+Nursing Service and improving delivery efficiency can help ensure that nurses’ efforts translate into measurable improvements in patient outcomes and health system performance.

This study has several limitations. First, it captured nurses’ experiences during a specific phase of Internet+Nursing Service implementation in selected regions. As service models and policy support continue to evolve, the transferability of these findings to other settings or later stages may be limited. Future research could explore how regional differences and policy developments shape nurses’ experiences over time. Second, nurses with favorable views or positive experiences may have been more likely to agree to participate, introducing potential selection bias. Third, the recruitment strategy did not specifically target nurses who had withdrawn from the Internet+Nursing Service; perspectives from this group could further elucidate reasons for disengagement. Finally, although participants verified their transcripts for accuracy, the aggregated findings were not returned in order to safeguard participant privacy, which may have limited additional verification of our interpretations.

This study underscores the significant value of the Internet+Nursing Service in advancing patient-centered care, enhancing nurses’ professional fulfillment, and optimizing health care resource allocation. However, the findings also highlight critical concerns among nurses, particularly regarding safety, workload, and fair compensation, which require urgent attention. To fully harness the potential of the Internet+Nursing Service, the following measures are recommended:

First, establish standardized safety protocols, including clear emergency response mechanisms and comprehensive insurance coverage. Second, develop diversified communication and collaboration platforms to facilitate experience sharing and peer support among nurses. Third, enhance organizational support by integrating remote medical resources to provide real-time guidance and safeguard nurses’ well-being. Fourth, optimize service operations and refine human resource management to ensure both efficiency and quality.

By implementing these strategies, not only can nurses’ job satisfaction and sense of security be strengthened, but patients will also receive more efficient and high-quality care. Ultimately, these efforts will contribute to the sustainable development of the Internet+Nursing Service and provide a solid foundation for continued innovation and progress in the health care sector.