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TELE-NURSING: IS IT IN MY FUTURE?
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Chamberlain College of Nursing: NR-361-18683
Tele-nursing: is it in my future?.
According to NCSBN (1997) tele-nursing is “the practice of nursing over a distance using telecommunication technology.” It is the process where patients and nurses interact through the use of telecommunication devices. Examples of the tele-nursing include the use of phone, interactive video, phone triage, internet support and remote tele monitor. Tele-nursing involves the use of technology that enables nurses and patients to interact freely without compromising the privacy and safety of the patients’ information (Wu, et al., 2010). The technology used to enhance tele-nursing is divided into three parts hardware, software, and network. The hardware components include; computers such as desktops and laptops, palm computers, telephones, graphics card, sound cards, internal and external memories. Whereas software components include programs developed to make the following computer components to operate; printers, keyboards, monitor, mouse, microphone, speakers, web cameras, conference calls, word-processing, database, internet browsing, emails for example, Digi-scope program to collect patient info related to diabetes.
The world is not static, it continuous evolves over time and tele health is one of the components that is shaping the health care. Tele-nursing is shifting from the traditionally desktop computers to the use of laptops and palm computers. These computers and wireless technology have enabled tele-nursing to increasingly use portable computers (Hagan, et al., 2000). Portability of these devices allow nurses to remotely access medical records of the patients, electronically document information in the remote locations, allow nurse to perform their duties in the hospitals and community nursing setting and may be used in two way audio through video conference. Wireless network allow the nurse and patients to communicate remotely by providing the wireless networking between patients and hospital computers, wireless internet access, use of video conferencing between nurse and patient, use in email and instant messaging.
The efficiency of tele-nursing depends on the reliability of the software and network connectivity. For example, communication is faster and clear when the servers are functioning optimally. Software design is the service provider dependent thus designed to suit the requirements of the medical facility. Additionally, tele-nursing depend on the tele monitoring ring sensor which is worn by patient 24 hours/day (Ramelet, et al., 2014). These tele monitoring ring sensor transmits wireless data, enables home computers to analyze data, sends warning signals to the tele-nursing center and signals received provides diagnostic information thus enabling nurse to respond to any eventuality on time and accordingly hence reducing the case of emergency admission to the hospitals. Tele monitoring ring sensor is used by medical professionals such as doctors and nurses for the purpose of clinical purpose, monitoring and diagnostic function and local area network.
Additionally, the efficiency of tele-nursing relies on the nurse informatics where the nurse is required to collect accurate data from the patient, assess the information using knowledge and experience, retrieve all the documented information, utilize critical thinking skills, provide nursing interventions, continue to monitor and utilize available technology to improve service delivery as well as satisfies the needs of the patients(National Council of State Boards of Nursing (NCSBN)., 1997). It is important to understand that tele health nursing is practiced in the healthcare clinic, home, prisons, doctor’s office, mobile units, hospitals and tele health centers. However, the fastest growing application in the tele-nursing include remote monitoring, telephone triage, and home care. Home care tele-nursing relies on the tele monitoring ring sensor that permits the monitoring of physiologic parameters such as respiratory peak flow, blood pressure, blood glucose, heart sound, and weight measurements through phone or internet connection and patients data.
Through the use of the video link, patients are able to contact tele-nurse and seek consultation on how to address an issue concerning their health such as insulin injection, dressing wound, difficult to breath. Tele-nursing is also able to educate and counsel patients concerning health lifestyle. Tele health nursing is also used by call centers operated by managed care organizations, and staffed by RN case manager who conducts patient triage, education, counseling to regulate patients access/flow and decrease ER use (Ramelet, et al., 2014). Tele health nursing can also involve patients education, Tele consultation, conducting and communicating medical tests/results conducting physical exams/assessment and collaboration with healthcare providers in implementing medical treatment protocols and providing follow-up care.
Tele-nursing is employed when there is the need to deliver nursing care remotely and improve efficiency and access to healthcare. A nurse can tele present a patient to remote physician, nurse practitioner, or physician assistant for assessment, assessment and addressing the developing and non-developing consultations, program pre, and post care along with forensic mistreatment cases. Tele-nursing brings nursing care remotely and is also designers, instructors, creators, makers, researchers and implementers of the-nursing and eHealth services.
Legal issues
Tele-nursing is required to comply with legal requirements that include; maintaining patient privacy, verifying consent from the patients, compliances with HIPAA regulations, nursing licensure across state lines and maintaining compliances with scope of practice(Wu,et al., 2010). Every nurse with the intention of practice as tele-nursing needs to understand the basic legal and licensing requirements expected from the medical facility in terms of infrastructure. In terms of licensure, tele-nursing may be required to have additional licensure to practice across Stateline. In non-federal setting tele health nurses must have a register nurse license that complies with both state and federal regulations. In the US, the nurse licensure compact (NLC) allow RN’s to practice across compact members’ state lines.
Other legal issues that nurse are required to have is the competence. Nurse must meet standard of care for safe, quality and competent practice for tele health nursing by practicing within the ANA scope and standard of nursing practice. Specific tele health standard can be found in the American Academy of Ambulatory Care Nurse (AAACN) and American Nurse Association (ANA)(Hagan, et al., 2000). Tele-nursing is a set of competencies for any nurse to utilize and are defined by the ICN. Additionally, ethical concerns need to be looked at by the tele-nursing such as how to maintaining autonomy in terms of identity and privacy, maintaining patient’s integrity and prevent harm to a patient.
Advantages of tele-nursing
Tele-nursing has several advantages to both nurses and the patients. Some the advantages include;
– Increase public access to health care
– Increase patient compliance with aftercare
– Provide access to rural areas
– Increase continuity
– Decrease wait times
– Decrease healthcare costs
– Decrease unnecessary hospital visits
Disadvantages
– Decreased face-to-face interaction
– Concerns about maintaining confidentiality
– Risk of decreasing quality of care
– Concerns about security
– May increase liability.
Future of tele-nursing
As the US healthcare environment continues to evolve due to changes in reimbursement legal issues, and shrinking healthcare resources, the expanding role of tele health nurses will continue to evolve (Ramelet, et al., 2014). Leadership and collaboration among international nurses are needed to outline the uses of eHealth/tele health technologies to provide nursing care in an interdisciplinary manner to patients, regardless of staffing, time, or geographic boundaries. Ongoing development of new technologies provides endless possibilities for the future of nursing care.
References
Hagan, L., Morin, D., & Lepine, R. (2000). Evaluation of telenursing outcomes: satisfaction, self-care practices, and cost saving. Public Health Nurse, 17(4):305-313.
National Council of State Boards of Nursing (NCSBN). (1997). Telenursing. Retrieved from National Council of State Boards of Nursing: https://www.ncsbn.org/TelenursingPaper.pdf
Ramelet, A., Fonjallaz, B., Rapin, J., Gueniat, C. & Hofer, M. (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 Pedatrics, 151(14): 1471-2431.
Wu, L., Forbes, A., Griffiths, P., Millingan, P., & While, A. (2010). Telephone follow-up to improve glycaemic control in patients with Type 2 diabates: Systematic review and meta-analysis of controlled trials. Diabet Medicine, 27(11): 1217-1225.
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