Telehealth nursing

Telehealth nursing, or telenursing, is the practice of specially trained nurses using audio and video technology and advanced digital and optical communications to deliver health care. This type of health care is usually in the form of care management for emergent or chronic conditions, coordination of care, and health maintenance services. It is beneficial to both the patient and the nurse; the patient benefits from increased access to health care services, while the nurse benefits from a more flexible and less physically stressful work environment. It has been predicted that telehealth nursing will become more widespread in the future, and in 2020 the health crisis caused by the global COVID-19 pandemic seemed to reinforce that belief.

Background

Telehealth nursing is a subfield of a medical practice area known as telehealth or telemedicine. This refers to any health care delivered through some form of communication other than personal contact. The field is as old as the telephone. Within a few years of the first telephone patent being issued in 1876, at least one medical journal, The Lancet, was advocating the use of the telephone for physician-patient consultations to eliminate the need for some in-person appointments. Since that time, physicians and their nurses have frequently used the telephone to assess basic health issues, answer questions about medications and side effects, and reassure anxious patients. Twenty-four-hour access to nurse-staffed helplines has been a staple of health insurance benefits for many years.

What has brought the concept to the forefront is the increased availability and capability of new technology that can be used in the twenty-first century. Instead of merely listening to a parent describe his or her child's rash, for instance, a telehealth nurse, or telenurse, can use a video link to see it. This allows the nurse to use a wider range of training and experience to determine whether a situation is serious enough to require the in-person attention of a medical practitioner or whether another remedy can be recommended.

Telenurses can use technology to have virtual consultations with patients who need assistance with health improvement programs such as smoking cessation or weight loss. The connection can help patients stay on track with their efforts, provide encouragement and support, and help the nurse identify any potential issues that are arising. Prenatal patients and new mothers also benefit from these consultations.

Technology exists that allows a patient to connect in-home monitoring equipment, such as blood pressure devices and blood glucose monitors, to a computer that can communicate with the nurse's computer. The nurse has direct access to the readings and can determine whether a patient's condition is under control or is in need of some adjustment or care. Telenurses can provide guidance and assurance to patients managing complex and chronic conditions, helping to improve their health outcomes while also reducing the number of in-person visits these patients need. Telenurses can be valuable in helping senior patients with multiple health issues and patients with illnesses such as multiple sclerosis, hepatitis, AIDS, and other serious conditions to manage their conditions.

Improved technology allows telehealth nurses to access far more patient records than any single nurse in a physician's office could. Records from several associated offices or from many offices within an insurance network can be accessed from a single call center. This allows the nurse to provide more personalized care and to keep better records of the care administered via telenursing. The result is an improved patient experience that can often yield better outcomes. Fewer nurses are able to provide better care to more patients than would be possible if each office had to staff its own call center or if patients had to come in for in-person visits.

Overview

Telehealth nursing has evolved from simply answering questions about medications or the possible causes of symptoms to being an integrated part of health care management for many patients. Nurses working in this capacity can develop ongoing connections with patients that allow them to develop a better perspective on how a patient's treatment is progressing, what problems the patient is experiencing with his or her treatment, and other information that can help the physician and the patient's entire health care team provide better care. The technology-based consultations can provide more frequent interactions with patients who live in remote areas or who have barriers to coming to the physician's office, such as mobility or transportation issues.

Telenurses can serve as health coaches for people endeavoring to improve their health or for people recovering from life-altering medical situations, such as heart attacks or strokes. They often help to coordinate care for patients who see several physicians for multiple conditions, such as a patient with diabetes who needs to see a cardiologist for heart concerns, an ophthalmologist to monitor potential vision problems, and a podiatrist for proper foot care. Telenurses can serve as educators for people learning to cope with new illnesses or recovering from surgical procedures. In most cases, all of these efforts can be done with fewer staff and at a lower cost than in-person care would require.

The practice of telehealth nursing provides some benefits for nurses, too. For many telehealth nurses, the job provides shorter, more regular work hours. Telenursing can allow for more focused specialization if the nurse so desires. It can allow the nurse to develop better relationships with patients in his or her caseload. Telenursing can also provide a way for nurses who have problems with the physical aspects of nursing—long hours of standing, lifting patients, and so on—to continue practicing their skills.

While telenursing has many advantages, it also raises some concerns. Nurses sometimes worry that telenursing will eliminate jobs in the future. Others fear that the trend will lead to less personal health care, where in-person visits with nurses or physicians are the exception instead of the norm. Other concerns include the possibility of increased medical errors, the potential for medical problems to be missed by the lack of personal contact, and the greater possibility of electronic records theft and resulting medical fraud.

Telenursing became even more important and widespread as a means of reducing in-person contact for health care during the COVID-19 pandemic in 2020. As it was determined early on in the pandemic that the virus was easily transmittable, many people who would otherwise have been able to see a physician or nurse in person either became too concerned about going to facilities or were increasingly encouraged to avoid receiving in-person care unless there was an urgent need. Additionally, nurses had to balance patient care with their own safety. Especially in cases of hospitals and clinics that quickly became overburdened with COVID-19 patients and testing, companies within the health care industry began offering telehealth services such as audiovisual equipment and workstation software for telenursing at reduced or no cost to facilitate an increased need and promotion of telehealth. As part of this transition, policy changes were made that included an expansion of telehealth coverage on behalf of insurers and allowing nurses and physicians to use technology such as the videoconferencing applications Zoom and Skype to conduct consultations. Still, concerns such as access and quality of care remained.

Bibliography

Barrett, David. "Should Nurses Be at the Forefront of Telehealth?" The Guardian, 20 Jan. 2014, www.theguardian.com/healthcare-network/2012/jan/20/nurses-needed-at-telehealth-forefront. Accessed 20 Dec. 2016.

Bunn, Jennifer. "Telehealth—the Future of Healthcare?" Ausmed, 26 Oct. 2016, www.ausmed.com/articles/telehealth/. Accessed 20 Dec. 2016.

Edmunds, Marilyn W., et al. "Telehealth, Telenursing, and Advanced Practice Nurses." Journal of Nursing Practices, Apr. 2010, www.medscape.com/viewarticle/719335. Accessed 20 Dec. 2016.

Llewellyn, Anne. "Beyond the Bedside: The Role of Telehealth Nursing." Nursetogether.com, 23 June 2014, www.nursetogether.com/beyond-bedside-role-telehealth-nursing. Accessed 20 Dec. 2016.

Taylor, Goldie. "The Evolution of Telehealth Nursing." Minority Nurse, 8 Apr. 2016, minoritynurse.com/the-evolution-of-telehealth-nursing/. Accessed 20 Dec. 2016.

"Telehealth Nursing Practice." American Academy of Ambulatory Care Nursing, www.aaacn.org/telehealth. Accessed 20 Dec. 2016.

"Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic." CDC, 10 June 2020, www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html. Accessed 10 Sept. 2020.

Weselby, Cathy. "Is Telenursing for You?" Wilkes University, 28 Jan. 2015, onlinenursing.wilkes.edu/telenursing/. Accessed 20 Dec. 2016.

Westra, Bonnie. "Telenursing and Remote Access Telehealth." American Association of Colleges of Nursing, Oct. 2012, www.aacn.nche.edu/qsen-informatics/2012-workshop/presentations/westra/Telehealth.pdf. Accessed 20 Dec. 2016.