Running head: TELENURSING IN 2013 - BENEFITS AND CHALLENGES

Telenursing in 2013 Benefits and Challenges Patricia Thomas Thomas Edison State College Essentials of Nursing Informatics NUR-340-NU003 Dr. Callahan August 29, 2013

TELENURSING IN 2013 - BENEFITS AND CHALLENGES Abstract The future of nursing is at a pinnacle. With the emergence of electronic health technologies nurses now have additional tools to support and improve client care. The equipment that exists today allows for providing expert service from a remote location. And, although the technology has improved patient services and availability there are still many to overcome until telenursing is a fully integrated and accepted form of health care. As the delivery of nursing care changes, and with the implementation of evidence-based care, telenursing as a profession is one that is relevant in 2013 and the coming future.

Keywords: telenursing, telehealth, telemedicine, ehealth, remote nursing, nursing in 2013

TELENURSING IN 2013 - BENEFITS AND CHALLENGES Telenursing in 2013 Benefits and Challenges With the rapid onset of new technology, increased life spans, patients living with comorbidities, the implementation of the Affordable Care Act, and increased health care costs,

telenursing, has broader possibilities. Telenursing is exciting in that it requires the ability to teach and educate in a different manner than in-person care. Coming from a background as a technical services representative, telenursing seems like a perfect fit; the benefits of technology have greatly impacted the consumer product manufacturing environment. While researching the topic, it became very clear that no matter what the area of telenursing, the nurse must be well educated and experienced in the area in which the telecare will be provided. The availability of information, and the technology now available to transmit and receive it, is what makes the topic of telenursing so relevant to Nursing Informatics. Search Strategies Topic Availability Telenursing brought interest secondary to my previous role as a technical services supervisor. In this role service was provided via telephone, much like a telenurse might do with a patient. Although it is a fairly new field, over 1000 articles on CINAHL were located, with a similar amount on PubMed. Other articles were plentiful while doing regular google search. Some organizations that are specific to the topic of Telenursing include the American Telemedicine Association (ATA) and the National Council of State Boards of Nursing (NCSBN). Information Availability While performing my searches the following were utilized: Saba and McCormicks course textbook; the CINAHL database; PubMed; government websites; and internet searches on

TELENURSING IN 2013 - BENEFITS AND CHALLENGES Bing and Google. Some of the keywords that were used in the search included: telenursing,

telehealth, telemedicine, ehealth, remote nursing and, nursing in 2013. The information gathered was geared towards a combination of professionals and consumers. This really depended on where the information was obtained from. The CINAHL and PubMed searches were geared toward professionals, whereas the Internet search information was more consumer-based. Benefits. A fair number of us have probably struggled with calling the doctors office, seeking advice for a situation that may or may not be urgent. Not wanting to be a bother, yet concerned enough to feel the need to call. Maybe just needing some reassurance that the issue is not urgent, but usually the advice has always been to make an appointment and come in and see the doctor. Well times have changed and the acceptability, and extent of remote nursing (telenursing), has expanded into many areas of nursing and healthcare. Current technology has improved the ability to transmit and receive the critical information that makes telenursing possible. Shorter hospital stays means that the home-centered patient may need immediate response to an emergent situation. Similarly, the availability of the most advanced technology and trained personnel are not always available in more remote areas. Telenursing, as defined by the National Council of State Boards of Nursing (NCSBN) is the practice of nursing over distance, using telecommunications technology. The nurse engages in the practice of nursing by interacting with a client at a remote site to electronically receive the clients health status data, initiate and transmit therapeutic interventions and regimens, and monitor and record the clients response and nursing care outcomes (NCSBN, 1997, p. 1). The scope of telemonitoring devices is steadily increasing. Many of these devices allow for patient centered disease management and accountability. The nurse retrieves the information and alerts the physician about deviations or concerns. This allows for patient comfort and

TELENURSING IN 2013 - BENEFITS AND CHALLENGES flexibility by being able to stay in their own home. According to Saba and McCormick (2011), physical assessments are now being performed using smart stethoscopes and skin lesions can

be assessed from a remote area using high-intensity cameras (Saba & McCormick, 2011, p. 565). Research has demonstrated that wound assessment using video technology is comparable to inperson wound assessment and recent studies have shown that management of wound care via telehealth has demonstrated a significant cost savings over traditional care. An added benefit was the increase in knowledge of the remote nurse and patient, in wound management (Stokowski, 2008, p. 1). While performing wound care assessments at my place of employment, in long term care, it is often frustrating trying to decipher how the previous nurse interpreted or measured the status of a wound, so this technology is particularly exciting. Face to face consultations can easily take place via video conferencing. Vital statistics such as heart rate, blood pressure, pulse oximetry, weight, temperature, and blood glucose levels can now be transmitted electronically, for evaluation as well as for establishing baselines and tracking health patterns over time (Stokowski, 2008, p. 1). The application of telenursing extends beyond the home-based patient; many sophisticated telenursing functions include hospital to hospital nursing. In an article by Williams, Hubbard, Daye and Barden (2012), telenursing in the ICU is explained as this: In the tele-ICU, experienced ICU nurses and physicians help to monitor and treat critically ill patients, providing an additional layer of safety. Communication occurs via audio and video technology on demand from either the tele-ICU or the bedside so that nurses and physicians can interact immediately. Often remotely located from the actual hospital facilities, the tele-ICU has the ability to assess and monitor hundreds of patients through any electronic

TELENURSING IN 2013 - BENEFITS AND CHALLENGES technique in use at the patients bedside. Standard monitoring such as electrocardiography and hemodynamic values are maintained continually, and access to medical records, diagnostic images, and laboratory results is available with the click of a mouse. (Williams, et al., 2012, p. 2). The benefits of telenursing in the ICU are in the ability to have assistance from more highly trained personnel, as well as the advantages of utilizing more sophisticated equipment in remote areas. It would not be feasible for smaller facilities to maintain similar items on their own. This is reassuring knowing that there are experts available, on a global level. The use of telenursing to aid those in remote areas cannot be understated, and has proven to be a great resource in aiding and pinpointing areas that have recurring health concerns. For example, according to Saba and McCormick (2011), villagers in Zimbabwe have been trained to transmit data related to malaria, infant mortality rates and maternal deaths. By analyzing the data that has been transmitted, health personnel have been deployed to the villages in need (Saba & McCormick, 2011, p. 563). To summarize, the benefits of telenursing include: increased public access to healthcare, access in remote areas, decreased costs, decreased wait times, patient comfort, increased patient involvement, and the ability to monitor patients over an extended period of time, without interrupting their lifestyle. This has been personally evidenced, as a family member was able to be remotely monitored with an external defibrillator, while awaiting an internal implant. It was comforting to know that this technology was a potential life-saver.

TELENURSING IN 2013 - BENEFITS AND CHALLENGES Challenges. Along with the innovations to telemedicine and telenursing there are many challenges facing this area of nursing. Saba and McCormick (2011) explains that there is a lack of infrastructure for interstate licensure which is impeding the growth of telehealth (Saba & McCormick, 2011, p. 569). Steps have been taking by the NCSBN to reduce these barriers and 22 states have enacted the nurse them to practice in other states without having to get a new license (Saba & McCormick, 2011, p. 569). Additionally, a high percentage of patients that are in need of these services are elderly and are ill or immobile. Many of the residents do not have the means or family support to attend regular examinations. They also may not be physically or mentally able to comply with the technology needed to support telenursing in a successful manner. An article in an NCSBN (1997) publication also brings up the concern for regulators as to how does the caller know that the individual who receives the call is a nurse. Is public expectation that identification, by name and credential, of the receiver be required? If so, how is this verified? (NCSBN, 1997, p. 1). And perhaps most importantly is the role of the nurse as a caregiver. How can a nurse convince the recipient they are a sincere and concerned caregiver? Jones, Hendricks and Cope

(2012) describe caring as encompassing thoughts, emotions and actions coming together within a moral imperative to provide comfort, both physical and emotional, from another individual (Jones et al., 2012, p. 3). With telenursing effective therapeutic communication is the key to achieving this. Although there are obstacles to overcome in telenursing, they are not insurmountable, and will only serve to improve patient outcome and comfort. The technology available is mind boggling. I am still impressed (and clueless) as to how a radio receives sound, much less how an x-ray can be wirelessly transmitted in a few seconds, to other parts of the world. If telenursing

TELENURSING IN 2013 - BENEFITS AND CHALLENGES will improve patient comfort and patient outcomes, and if more opportunities are available for nurses as a result, than this is an area that should be embraced. However, we will never replace

the bedside nurse. The concept of caring, as mentioned above, is one that encompasses more than just a voice. Some people may need that close contact more than others. Just last night I had a resident ask me to stop touching her. She exclaimed Stop touching me, I am not a dog. Others appreciate this. I believe there is a place for telenursing, just as there are many other different areas of nursing care. Conclusion Telenursing will continue to grow, as a profession. The technology allows for it, as well as the need to control healthcare costs. The nursing care received in telenursing is as good as the nurse providing it, but this is not dissimilar to any other areas of nursing. The type of nurse needed to retrieve information and maintain the hardware, may open doors for nurses that have qualities that may not include bedside manners. With the changing face of the job market, looking to the future for satisfying and rewarding jobs, telenursing has its place in health care. Smarthinking The Smarthinking critique of my paper suggested I do not use clichs, such as in conclusion. They also suggested that I use more commas to have my sentences flow better, and not be confusing (although I do tend to be over zealous with the commas most times) and, they suggested that I flow from one idea to another with better lead-ins (as in additionally at the start of a sentence. I did incorporate their suggestions. The tutor commented that my essay was very well organized, with the use of the headings and subheadings.

TELENURSING IN 2013 - BENEFITS AND CHALLENGES References Jones, M., Hendricks, J. M., & Cope, V. (2012). Toward an understanding of caring in the context of telenursing. International Journal for Human Caring, 7-15. Retrieved from http://persimmon.tesc.edu:2056/ehost/pdfviewer/pdfviewer?sid=e92ab0d8-dc2e-497cb9aa-236e2908dc9f%40sessionmgr198&vid=39&hid=113 NCSBN. (1997). The national council of state boards of nursing position paper on telenursing: A challenge to regulation. Retrieved from https://www.ncsbn.org/TelenursingPaper.pdf Saba, V. K., & McCormick, K. A. (2011). Educational applications. In J. Morita, & P. J. Boyle

(Eds.), Essentials of Nursing Informatics (5th ed., p. 565). New York, NY: McGraw-Hill Companies, Inc. Shea, K., & Chamoff, B. (2012). Telehomecare communication and self-care in chronic conditions: Moving toward a shared understanding. Worldviews on Evidence-Based Nursing, 109-116. http://dx.doi.org/http://persimmon.tesc.edu:2068/10.1111/j.17416787.2012.00242.x Stokowski, L. A. (2008). Healthcare anywhere: The pledge of telehealth. Retrieved from http://www.medscape.com/viewarticle/581800_4 Williams, L.M., Hubbard, K. E., Daye, O., & Barden, C. (2012). Tele-ICU enhancements. Telenursing in the intensive care unit: Transforming nursing practice. Critical Care Nurse, 62-69. http://dx.doi.org/http://persimmon.tesc.edu:2068/10.4037/ccn2012525