Telenursing: Is it for Me?
Fifty years ago, the kind of technology depicted in science-fiction films may have seemed like an unattainable fantasy. Today, it is a reality. Advancements in technology in every sector of life have made it so that human beings now have more communicative power than ever before: information can be conveyed digitally and electronically faster than the blink of an eye. This technology is now being instituted in the health care industry in the form of telehealth. Telehealth is a form of medicine that utilizes telecommunications technologies and electronic storage to make long-distance clinical care a real and effective practice in today’s world (Hebda, 2013). This paper will provide an assessment of one area of telehealth, which is telenursing and include a discussion of the advantages and disadvantages for the patient as well as legal and ethical principles for the nurse using telenursing.
One of the biggest concerns of telenursing is privacy: with a monitor that shows the activities of a patient in a private setting, what information is conveyed to whom? Fortunately HIPAA laws are in place to protect client privacy. Personnel using telenursing technology would be required to sign in to access information using access codes, just like they would with any other form of clinical information. Privacy of the patient is to respected just as it would be were the patient in a hospital receiving care. The advantage of telenursing is that it provides the same level of monitoring and care but allows the patient to be in his or her own private residence (Hebda, 2013). Still, the newness of the technology and concerns about privacy that coincide with electronic information conveyance, especially in today’s world where cyber attacks are more or less a given, could be perceived as a disadvantage to the utilization of telenursing.
Another disadvantage is that the malpractice claims could be instigated if telenursing operatives are not supported by a strong organizational environment (Roing, Holmstrom, 2015). Additionally, as Roing, Rosenqvist and Holmstrom (2013) indicate, because the “main sources of information” in telenursing are the nurses’ “dialogues with the callers, the provision of safe can care can depend on the quality of this dialogue” (p. 969). If the operatives are not skilled in maintaining a successful dialogue with patients, optimal care could be lost — and this is another perceptible disadvantage.
However, with the right training and organizational staff to support it, telenursing’s advantages could far outweigh these perceived disadvantages. For one thing, a higher degree of patient satisfaction has been shown to be one of impacts of telenursing, because the patient can be more comfortable in surroundings that are less intrusive (Odeh, 2014). Patients are more likely, also, to be communicative with telenursing operatives as they see this as a direct link to care and they discern their own pro-active part in the provision of that care. In terms of interoperability, telenursing is also another advantage to the health care industry, because it promotes greater team work and a positive organizational culture that integrates communication with care in a manner that is conducive to 21st century technological levels of interaction.
Telenursing can also be helpful as a follow-up application as Ramelet et al. (2014) indicate. Their study on how children with rheumatic diseases were supported via telenursing follow-up calls showed that patient satisfaction was high thanks to the efforts made by such specialist nurses in connecting with patients after discharge and providing adequate information and support regarding consultations, treatment options, advice and more.
Perhaps one of the biggest advantages to telenursing is the fact that it reduces the number of hospitalizations that patients would otherwise undergo. The study by Kamei et al. (2013) showed that “the effects of telehome monitoring-based telenursing on health outcomes and use of healthcare services” were “decreased hospitalization rates, emergency department visits, exacerbations, mean number of hospitalizations, and mean duration of bed days of care” among patients with chronic obstructive pulmonary care (p. 180). If telenursing can reduce the number of patients taking up bed space in hospitals it can free up beds for other patients who may need more immediate care and reduce waits in waiting rooms. Telenursing, in other words, could streamline health care services and make health care more effective in treating persons on a one-on-one basis. Not only that, but telenursing clearly provides the requisite level of monitoring and assessment that in-house treatment provides, as this study shows.
Ethical concerns regarding telenursing are no different than they are in any other area of specialized nursing. Ethical practices should be observed in terms of transparency, accountability, honesty and integrity. Reporting systems should be in place and part of the overall support given to telenursing specialists. These concerns are especially important in maintaining levels of patient satisfaction, as telenursing depends upon the nurse’s ability to communicate with the patient and the relevant information to be exchanged between the two, so that the proper care and treatment can be provided as a result.
My recommendation is that telenursing is very much the future of health care. Thanks to the technology that we now have, telenursing is not only possible but highly advantageous, as it helps patients to feel more comfortable and more provided for due to telenursing follow-ups or telehome monitoring; and it also helps clinics and hospitals to reduce the cost of taking patients in who can be just as easily and more comfortably monitored from home. It frees up space for other patients who may need beds or immediate treatment/care, and it cultivates strong relationships between providers and patients, who appreciate the direct albeit long-distance connection between the nurse and the patient wherever he or she is.
My own current position is that there are many great advantages to telenursing, as described above, and that these outweigh the perceived drawbacks. So long as the necessary support and organizational framework is in place, telenursing is a good way to provide care in the 21st century.
As I currently work on an extremely busy medical surgical floor, I know that computer systems make our lives a lot easier and I for one could not imagine being without them. Information is conveyed, stored and accessed with ease, and monitoring is performed effectively as a result of these systems. Using these same systems over long-distances is the logical next step in the evolution of health care.
Because I am the type of nurse who is always up for change, I look forward to telenursing and believe that is a form of specialized care that would be a good fit for me, as I am not at all uncomfortable with technology or telecommunications. In today’s world of medicine, one has to stay informed on the latest changes and developments so as to stay relevant and efficient. Telenursing can improve all our lives by allowing for better time management, resource management, space management, and patient management. Seeing the patient outside of the acute care setting is just one of the many bonuses of implementing telenursing.
References
Hebda, T., & Czar, P. (2013). Handbook of informatics for nurses & healthcare professionals (5th ed.). Boston, MA: Pearson.
Kamei, T. et al. (2013). Systematic review and meta-analysis of studies involving telehome monitoring-based telenursing for patients with chronic obstructive pulmonary disease. Japan Journal of Nursing Science, 10(2); 180-192.
Odeh, B. (2014). Implementing a telehealth service: nurses’ perceptions and experiences. British Journal Of Nursing, 23(21): 1133-1137.
Ramelet, A. et al. (2014). Impact of a Telenursing service on satisfaction and health outcomes of children with inflammatory rheumatic diseases and their families: a crossover randomized trial study protocol. BMC Pediatrics, 14: 151.
Roing, M., Rosenqvist, U., Holmstrom, I. (2013). Threats to patient safety in telenursing
as revealed in Swedish telenurses’ reflections on their dialogues. Scandinavian Journal of Caring Sciences, 27(4): 969-976.
Roing, M., Holmstrom, I. (2015). Malpractice claims in Swedish telenursing: Lessons learned from interviews with telenurses and managers. Nursing Research, 64(1): 35-43.
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