Nurses face new situations and challenges with today’s rapid growing information technology and telecommunication systems. Telehealth is a progressively advancing system that incorporates the use of technology to enhance patient care in the most effective and efficient way possible at a distance (Epidirippulige, 2010). Telenursing is a part of telehealth that is gaining significant growth as a subspecialty. “The use of remote patient monitoring, often referred to as telehealth, has been widely adopted by health care providers, particularly home care agencies” (Suter et al., 2011). Patients with chronic health diseases such as congestive heart failure (CHF) benefit from telehealth services. The use of Telenursing services can improve health outcomes, promote self-care through guidance and education, as well as decrease readmissions to the hospital and their related medical cost. Telenursing is emerging rather quickly due to the ongoing shortage of nurses globally. “New ways to manage chronic illness are imperative, especially as the population ages, chronic illness increases and the nursing shortage continues” (Bowles et al., 2009, p. 344).
The purpose of my research is to provide information on the role of nursing in telehealth practices, the advantages and disadvantages for patients, as well as legal factors to consider when providing nursing care to patients with chronic illnesses within home health agencies. Telenursing is defined by the National Council of State Boards of Nursing (NCSBN) as “the practice of nursing over distance using telecommunications technology” (American Telemedicine Association (ATA), 2008). A few examples of terms commonly used to refer to telehealth are: telenursing, telecare, telemonitoring, telehomecare and telemedicine (Artinian, 2007). All of which are “the provision of clinical care at a distance through the use of electronic communication and information technologies” (Artinian, 2007, p. 25).
Telehealth services can be offered at doctor’s offices, hospitals, and within the patient’s home. Through the use of telephones, video, computers, and other monitoring equipment patients have the capability of receiving expert quality medical care. It allows patients the ability to feel comfortable knowing a health professional is monitoring their illness regularly and not only between doctor visits. The role of a Telenurse is a unique approach to nursing care and component of the telehealth system. “The nurse engages in the practice of nursing by interacting with a client at a remote site to electronically receive the client’s health status data, initiate and transmit therapeutic interventions and regimens, and monitor and record the client’s response and nursing care outcomes” (NCSBN Position Paper on Telenursing: A Challenge to Regulation, 1997).
Telehealth nursing (THN) allows nurses to see more patients on a daily basis, while decreasing the over-all work load of the nurses on a unit due to understaffing issues. The nurse can accomplish this without leaving the hospital or doctor’s office, saving considerable amounts of time by using interactive telehealth equipment, allowing other health care professionals to focus on patients admitted with emergencies. Nurses have access to the patient’s health issues and provide education as well as counseling regarding their disease processes and management as they progress. Effective communication between the nurse, family and patient is a vital role for successful management of the disease process and for the encouragement of patient involvement with self-care.
The availability of telehealth nursing offers numerous advantages to patients with chronic health diseases. More and more home care agencies are beginning to offer telehealth services due to the advantages in improvements in health care outcomes, decreased re-hospitalizations and medical costs, as well as promoting patients to become more proactive with their disease management. Depending on the severity of the patient’s medical condition, these benefits can be accomplished with the proper devotion to treatments and telehealth monitoring systems in place. Patients with chronic diseases tend to make more visits to the hospital and develop more health care expenses than patients without chronic health diseases (Suter et al., 2011). Within the comforts of their home, patients are able to obtain their vital signs and report symptoms using medical technology (blood pressure machine, glucometer, weight scale or pulse oximetry) and reported to the THN via the telephone, in-person through home visits, or by telemonitoring (Bowels et al., 2009).
The information provided by the patient allows the nurse to make decisions based on the patient’s symptoms and vital signs. A perfect example, as reported by Edirippulige (2010), is through wound care management, here studies have shown to prove that THN care can be quick and effective with the ability to take digital images of the wound during an at home visit. Both the THN and wound care specialist were able to collaborate and make necessary treatment plans, resulting in fewer at home visits, a reduction in healing time, and the prevention of hospitalization (Edirippulige, 2010). A second advantage to THN is the promotion of self-care management. According to Shea & Chomoff (2012), “patients who are active in self-care communicate with healthcare providers and develop partnerships as collaborators” (p. 111). This allows patients to develop the knowledge and skills needed to gain the confidence with the management of their medical problems including “regular assessment of progress and problems, goal setting, and problem-solving support” (Suter et al., 2011, p. 111).
Therefore, decreasing the possibility of their disease process from becoming worse and prevent unnecessary hospitalizations. A third advantage is the ability of telehealth services to offer frequent follow-up care to patient’s that can lead to fewer complications with their disease management (Artinian, 2007). While there are great advantages to THN disadvantages have also been seen that can lead to unsuccessful implementation of telehealth services. One disadvantage to THN is the patient’s lack of motivation, which can interfere with the patient’s ability to collect data appropriately necessary to provide quality nursing care. Therefore, it is important to assess the patient’s readiness to learn for appropriate disease management. Another disadvantage is lack of communication.
Shea & Chamoff (2012), stated that “Patients who do not talk to the nurse as often may rely on the telemonitored data more, but because of lack of communication, the THN does not know that the information is being used for self-care” (p. 114). Maintaining effective communication by offering detailed information regarding the plan of care and goals between the patient and nurse can prevent misunderstandings that may implicate the patients’ health condition. Lastly, age can be a factor. In a study conducted by Bowles (2010), “patients who refused to use the technology were significantly older than those who accepted it” (p. 3).
Conclusion and Recommendations
My research has shown that telehealth can improve the overall quality of patient care at a distance by reducing readmissions to the hospital and its related medical cost, promote self-care, and improve health outcomes. A telehealth nurse can play a vital role with the success of home health agencies providing telehealth services. Before recommending that you apply for the position of THN, there are certain aspects to keep in mind when it comes to guidelines and legalities. It is important to understand your role at adhering to “the standards of quality, patient privacy and confidentiality as established in traditional nursing practice and governed law” (ATA, 2008, p. 2). Artinian 2007, (as cited by ANA, 1999), reported that “in 1999 the American Nursing Association published Core Principles on Telehealth describing professional standards in telehealth” (p. 29).
These guidelines provide information to assist nurses with protecting a client’s privacy when services are rendered. Be cautious of licensure issues. There may come a time when you may receive directions from a provider on behalf of a patient who is located in another state. It’s important to practice within your state jurisdiction. Legal issues on behalf of negligence may arise. It is the responsibility of the nurse to understand and know how equipment is used. To avoid negligence, “staff and patients must be educated about the proper use and care of any telehealth devices” (Artinian, 2007, p. 29). I wish you luck and hope that I was able to provide you with enough information to support your decision.
American Telemedicine Association. (2008). Telehealth nursing: A white paper developed and accepted by the telehealth nursing special interest group. Artinian, N. (2007). Telehealth as a tool for enhancing care for patients with cardiovascular disease. Journal Of Cardiovascular Nursing, 22(1), 25-31. Bowles, K. H. (2010). Achieving meaningful use with information technology: telehealth research. Online Journal Of Nursing Informatics, 14(3). Bowles, K. H., Holland, D. E., & Horowitz, D. A. (2009). A comparison of in-person home care, home care with telephone contact and home care with telemonitoring for disease management. Journal of telemedicine and telecare,
15(7), 344-350. Edirippulige, S. (2010). Readiness of nurses for practicing telehealth. Studies In Health Technology & Informatics, 16149-56. National Council of State Boards of Nursing (NCSBN). (1997). Position Paper on Telenursing: A Challenge to Regulation. https://www.ncsbn.org/TelenursingPaper.pdf Shea, K., & Chamoff, B. (2012). Telehomecare Communication and Self-Care in Chronic Conditions: Moving Toward a Shared Understanding. Worldviews On Evidence-Based Nursing, 9(2), 109-116. doi:10.1111/j.1741-6787.2012.00242.x Suter, P., Suter, W., & Johnston, D. (2011). Theory-Based Telehealth and Patient Empowerment. Population Health Management, 14(2), 87-92. doi:10.1089/pop.2010.0013
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