What is telenursing?

Telenursing is the use of technology, specifically telecommunications, to administer nursing care and other nursing practices. Telenursing is just one subset of the telehealth practice, which is the delivery of health services via telecommunications technologies. The use of technology changes how nursing care is delivered, but it does not alter the nursing process or scope of the practice. Tools used in telenursing include the Internet, biosensors, digital assessment tools, and telemonitoring equipment. Telenursing is typically utilized when there is a great distance between the nurse and the patient. There are several factors that have led to the rise in telenursing, such as an increase in the number of aging and chronically ill patients and concerns with lowering the cost of health care. While there are many benefits to telenursing, there are some drawbacks and legal issues surrounding the practice.

Brief History

Telenursing initially began with telephone calls between nurses and patients to discuss the patient’s condition, at least as far back as 1974. M. Chahl-Horton conducted the first nationwide study in the United States on the role of telenursing in 1996. She found that 80 percent of nurses working in a telenursing program reported that they were able to meet with all of their patients via telecommunications. The next major study was conducted in 2000 by Loretta Schlachta-Fairchild, founder of iTelehealth, a market research and business development firm dedicated to expanding telemedicine. That study focused on the professional role of telenurses, including work satisfaction, role stress, and role conflict. This web-based national survey of telenurses found that since 1996, there had been a 600 percent increase in the number of telenurses active in the United States. It also found that 26 percent of active telenurses were advanced practice nurses, which means they hold master’s or doctoral degrees in a nursing specialty and can act as primary care providers.

A follow-up study was conducted by iTelehealth in 2004 and 2005 with telenurses in thirty-six countries around the world, of which the United States and Canada saw the highest participation, followed by Australia and the United Kingdom. This study also found the most common types of patients monitored by telenurses were chronic care, medical/surgery, pediatrics, coronary care, and obstetrics and gynecology. Role preparation for telenurses ranged from none to six months of orientation and that patient safety strategies ranged from none to extensive training and informed consent.

Overview

Telenursing is a subset of telehealth that specializes in the provision and management of nursing care and services using telecommunications technology. The job of a telenurse typically entails providing care for either individual patients or a defined patient population through telecommunications, such as the Internet, video conferencing tools, and electronic monitoring devices. Telenurses usually monitor patients who are suffering from a chronic condition, help patients manage their symptoms, and help coordinate the care a patient requires from other health-care professionals. This sort of work is very knowledge intensive, and nurses must be able to work independently, make decisions, provide advice on self-care, and make referrals to appropriate sources of help.

Initially telenurses only had telephones at their disposal, which limited their role. With vast improvements in technology, particularly in the 2000s, the role of telenurses has expanded. Contemporary telenurses use a diverse range of telecommunications devices to perform their duties and transfer information between themselves and their patients. With these technologies, telenurses can utilize clinical protocols and algorithms to assess patient needs and symptoms, prioritize the urgency of patient needs, collaborate with the patient and other health-care professionals, and evaluate individual outcomes.

Applications

Patient consultations are one of the major applications for telenursing. Common consultations sessions include a follow-up discussion after a procedure, patient education as part of a management program, and even physical exams that can involve diagnoses and treatment. Technology allows telenurses to include images, audio, and video into their consultations as necessary. During a consultation, a telenurse may also facilitate communication between a patient and another health-care provider.

Another major application of telenursing is remote monitoring, in which a patient uses a device in his or her home that collects and transmits medical data to clinicians. These devices can be used to supplement or even replace visits from a nurse to the home.

Benefits

One major benefit of telenursing is the transfer of data between the nurse and the patient. When a patient can see his or her own data, the individual begins to understand the illness better, which in turn allows for better disease management on the individual’s part and reduces patient dependency on hospitals and other care services.

Telenursing applications are especially popular in the home-care field, where the technology is used to deliver care to more patients without the need of more nurses. Since nurses do not need to spend time on the road, driving to individual patients’ homes, more time can be spent on direct patient care.

Many times, patients require a procedure that can only be done in a hospital that is far from home. Telenursing allows these patients to follow up with their nurses without having to make the trip again. This ability to connect patients with medical resources that do not exist in their area is another major benefit of telenursing.

Drawbacks and Challenges

The greatest major drawback in telenursing is that the nurse cannot examine the patient in person, limiting the sensory data that the nurse can collect. This could lead to misdiagnoses and, in turn, legal issues such as malpractice suits. This is why clear and concise communication is so critical in the telenursing field. Ethics has long been one of nursing’s central concepts. With telenursing, ethical dilemmas have been introduced that were not as prevalent in regular nursing. Ensuring a patient’s privacy, security, and confidentiality, for example, has become a major issue. Since this information is transferred electronically, proper security precautions must be taken. Other hurdles to telenursing include access to and funding for high-quality equipment, the potential for greater emotional distance between practitioner and patient, insurance reimbursement, and professional licensure or certification.

Bibliography

American Telemedicine Association. Telenursing Fact Sheet. Washington: Amer. Telemedicine Assn., Apr. 2011. Digital file.

Hagan, Louise, Diane Morin, and Rachel Lépine. "Evaluation of Telenursing Outcomes: Satisfaction, Self-Care Practices, and Cost Savings." Public Health Nursing 17.4 (2000): 305–13. Print.

Kiss, Jemima. "Liz Kendall: ‘Technology Can Stave Off the Crisis in the NHS.’" Guardian. Guardian News and Media, 1 May 2015. Web. 24 May 2015.

Reierson, Inger Åse, Hilde Solli, and Ida Torunn Bjørk. "Nursing Students’ Perspectives on Telenursing in Patient Care after Simulation." Clinical Simulation in Nursing 11.4 (2015): 244–50. Web. 24 May 2015.

Ricket, Edward W. "Improving Access in Healthcare through the Use of Telemedicine, Telepharmacy and Telenursing." Inside Counsel. ALM Media, 4 Mar. 2015. Web. 22 May 2015.

Sharpe, Charles C. Telenursing: Nursing Practices in Cyberspace. Westport: Auburn House, 2001. Print.

Snooks, Helen A., et al. "Real Nursing? The Development of Telenursing." Journal of Advanced Nursing 61.6 (2008): 631–40. Print.

Weinstein, Ronald S., et al. "Telemedicine, Telehealth, and Mobile Health Applications That Work: Opportunities and Barriers." Amer. Jour. of Medicine 127.3 (2014): 183–87. Print.