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Running head: TELENURSING IN 2013 - BENEFITS AND CHALLENGES

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Telenursing in 2013 – Benefits and Challenges Patricia Thomas Thomas Edison State College Essentials of Nursing Informatics NUR-340-NU003 Dr. Callahan August 29, 2013

With the emergence of electronic health technologies nurses now have additional tools to support and improve client care. The equipment that exists today allows for providing expert service from a remote location. As the delivery of nursing care changes. 2 Keywords: telenursing. ehealth. telenursing as a profession is one that is relevant in 2013 and the coming future.BENEFITS AND CHALLENGES Abstract The future of nursing is at a pinnacle. although the technology has improved patient services and availability there are still many to overcome until telenursing is a fully integrated and accepted form of health care.TELENURSING IN 2013 . nursing in 2013 . remote nursing. And. and with the implementation of evidence-based care. telemedicine. telehealth.

it became very clear that no matter what the area of telenursing. has broader possibilities.BENEFITS AND CHALLENGES Telenursing in 2013 – Benefits and Challenges With the rapid onset of new technology. and increased health care costs.TELENURSING IN 2013 . with a similar amount on PubMed. In this role service was provided via telephone. Search Strategies Topic Availability Telenursing brought interest secondary to my previous role as a technical services supervisor. Information Availability While performing my searches the following were utilized: Saba and McCormick’s course textbook. the CINAHL database. While researching the topic. Other articles were plentiful while doing regular google search. the benefits of technology have greatly impacted the consumer product manufacturing environment. PubMed. over 1000 articles on CINAHL were located. the nurse must be well educated and experienced in the area in which the telecare will be provided. Although it is a fairly new field. patients living with comorbidities. much like a telenurse might do with a patient. government websites. is what makes the topic of telenursing so relevant to Nursing Informatics. and internet searches on . Telenursing is exciting in that it requires the ability to teach and educate in a different manner than in-person care. telenursing seems like a perfect fit. 3 telenursing. the implementation of the Affordable Care Act. Some organizations that are specific to the topic of Telenursing include the American Telemedicine Association (ATA) and the National Council of State Boards of Nursing (NCSBN). Coming from a background as a technical services representative. The availability of information. and the technology now available to transmit and receive it. increased life spans.

Many of these devices allow for patient centered disease management and accountability. The nurse retrieves the information and alerts the physician about deviations or concerns. has expanded into many areas of nursing and healthcare.TELENURSING IN 2013 . 1997. yet concerned enough to feel the need to call.” Well times have changed and the acceptability. A fair number of us have probably struggled with calling the doctor’s office. the availability of the most advanced technology and trained personnel are not always available in more remote areas. This really depended on where the information was obtained from. This allows for patient comfort and . remote nursing and. initiate and transmit therapeutic interventions and regimens. and monitor and record the client’s response and nursing care outcomes (NCSBN. 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. seeking advice for a situation that may or may not be urgent. whereas the Internet search information was more consumer-based. Some of the keywords that were used in the search included: telenursing. The scope of telemonitoring devices is steadily increasing. using telecommunications technology. The information gathered was geared towards a combination of professionals and consumers. Telenursing. 1). Shorter hospital stays means that the home-centered patient may need immediate response to an emergent situation.BENEFITS AND CHALLENGES Bing and Google. ehealth. as defined by the National Council of State Boards of Nursing (NCSBN) is the practice of nursing over distance. telemedicine. Maybe just needing some reassurance that the issue is not urgent. Benefits. The CINAHL and PubMed searches were geared toward professionals. Similarly. but usually the advice has always been to “make an appointment and come in and see the doctor. p. and extent of remote nursing (telenursing). nursing in 2013. 4 telehealth. Not wanting to be a bother. Current technology has improved the ability to transmit and receive the critical information that makes telenursing possible.

p. Daye and Barden (2012). it is often frustrating trying to decipher how the previous nurse interpreted or measured the status of a wound.TELENURSING IN 2013 . 2011. An added benefit was the increase in knowledge of the remote nurse and patient. Communication occurs via audio and video technology on demand from either the tele-ICU or the bedside so that nurses and physicians can interact immediately. Face to face consultations can easily take place via video conferencing. p. 1). pulse oximetry. in long term care. experienced ICU nurses and physicians help to monitor and treat critically ill patients. for evaluation as well as for establishing baselines and tracking health patterns over time (Stokowski. Often remotely located from the actual hospital facilities. Hubbard. blood pressure. physical assessments are now being performed using “smart stethoscopes” and skin lesions can 5 be assessed from a remote area using high-intensity cameras (Saba & McCormick. 2008. temperature. so this technology is particularly exciting.BENEFITS AND CHALLENGES flexibility by being able to stay in their own home. 565). Vital statistics such as heart rate. telenursing in the ICU is explained as this: In the tele-ICU. the tele-ICU has the ability to assess and monitor hundreds of patients through any electronic . providing an additional layer of safety. many sophisticated telenursing functions include hospital to hospital nursing. 1). The application of telenursing extends beyond the home-based patient. Research has demonstrated that wound assessment using video technology is comparable to inperson wound assessment and recent studies have shown that management of wound care via telehealth has demonstrated a significant cost savings over traditional care. weight. According to Saba and McCormick (2011). and blood glucose levels can now be transmitted electronically. 2008. In an article by Williams. While performing wound care assessments at my place of employment. in wound management (Stokowski. p.

563). It would not be feasible for smaller facilities to maintain similar items on their own. 6 . infant mortality rates and maternal deaths. 2). patient comfort.BENEFITS AND CHALLENGES technique in use at the patient’s bedside. and the ability to monitor patients over an extended period of time. on a global level. health personnel have been deployed to the villages in need (Saba & McCormick. access in remote areas. The use of telenursing to aid those in remote areas cannot be understated. p. while awaiting an internal implant. decreased costs. 2012. according to Saba and McCormick (2011). For example. increased patient involvement. et al.. It was comforting to know that this technology was a potential life-saver. (Williams. villagers in Zimbabwe have been trained to transmit data related to malaria. The benefits of telenursing in the ICU are in the ability to have assistance from more highly trained personnel. the benefits of telenursing include: increased public access to healthcare. and access to medical records. as a family member was able to be remotely monitored with an external defibrillator. By analyzing the data that has been transmitted. 2011. p. This is reassuring knowing that there are experts available. as well as the advantages of utilizing more sophisticated equipment in remote areas. without interrupting their lifestyle. This has been personally evidenced. and laboratory results is available with the click of a mouse. and has proven to be a great resource in aiding and pinpointing areas that have recurring health concerns.TELENURSING IN 2013 . diagnostic images. decreased wait times. Standard monitoring such as electrocardiography and hemodynamic values are maintained continually. To summarize.

Along with the innovations to telemedicine and telenursing there are many challenges facing this area of nursing. 2011. to other parts of the world. How can a nurse convince the recipient they are a sincere and concerned caregiver? Jones. 569). The technology available is mind boggling. Hendricks and Cope 7 (2012) describe caring as encompassing thoughts. Additionally. And perhaps most importantly is the role of the nurse as a caregiver. They also may not be physically or mentally able to comply with the technology needed to support telenursing in a successful manner. 1997. I am still impressed (and clueless) as to how a radio receives sound. If telenursing . how is this verified? (NCSBN. An article in an NCSBN (1997) publication also brings up the concern for regulators as to how does the caller know that the individual who receives the call is a nurse. they are not insurmountable. from another individual (Jones et al. by name and credential. 2012. of the receiver be required? If so. Many of the residents do not have the means or family support to attend regular examinations. 2011. Is public expectation that identification. much less how an x-ray can be wirelessly transmitted in a few seconds. p. a high percentage of patients that are in need of these services are elderly and are ill or immobile. p. 3). p. and will only serve to improve patient outcome and comfort.TELENURSING IN 2013 . Steps have been taking by the NCSBN to reduce these barriers and 22 states have enacted the nurse them to practice in other states without having to get a new license (Saba & McCormick.. Although there are obstacles to overcome in telenursing. emotions and actions coming together within a moral imperative to provide comfort. p.BENEFITS AND CHALLENGES Challenges. With telenursing effective therapeutic communication is the key to achieving this. both physical and emotional. Saba and McCormick (2011) explains that there is a lack of infrastructure for interstate licensure which is impeding the growth of telehealth (Saba & McCormick. 1). 569).

telenursing has its place in health care. than this is an area that should be embraced. is one that encompasses more than just a voice. Just last night I had a resident ask me to stop touching her. Conclusion Telenursing will continue to grow. such as “in conclusion. as mentioned above. may open doors for nurses that have qualities that may not include “bedside manners. The type of nurse needed to retrieve information and maintain the hardware. just as there are many other different areas of nursing care. with the use of the headings and subheadings. The tutor commented that my essay was very well organized. Some people may need that close contact more than others.” With the changing face of the job market. and not be confusing (although I do tend to be over zealous with the commas most times) and. as a profession. The nursing care received in telenursing is as good as the nurse providing it. However. Smarthinking The Smarthinking critique of my paper suggested I do not use clichés. I did incorporate their suggestions. looking to the future for satisfying and rewarding jobs.TELENURSING IN 2013 . as well as the need to control healthcare costs.” They also suggested that I use more commas to have my sentences flow better. but this is not dissimilar to any other areas of nursing. She exclaimed “Stop touching me. . The concept of caring. I am not a dog.” Others appreciate this. The technology allows for it.BENEFITS AND CHALLENGES will improve patient comfort and patient outcomes. and if more opportunities are available for nurses as a result. they suggested that I flow from one idea to another with better lead-ins (as in “additionally” at the start of a sentence. I believe there is a place for telenursing. we will never replace 8 the bedside nurse.

p.x Stokowski.com/viewarticle/581800_4 Williams. A.org/TelenursingPaper. Essentials of Nursing Informatics (5th ed. Boyle 9 (Eds.org/http://persimmon.pdf Saba.. Tele-ICU enhancements. & Barden. In J. M.BENEFITS AND CHALLENGES References Jones.4037/ccn2012525 .17416787. K. Worldviews on Evidence-Based Nursing. International Journal for Human Caring. (2011). & Cope. K. O. Critical Care Nurse. Retrieved from https://www. Daye.edu:2068/10.M. K. J. (1997). NY: McGraw-Hill Companies. Retrieved from http://www.doi. & Chamoff.TELENURSING IN 2013 .. (2008). Telehomecare communication and self-care in chronic conditions: Moving toward a shared understanding. L. Educational applications. B.medscape. C. http://dx.. J.tesc. Telenursing in the intensive care unit: Transforming nursing practice. http://dx. New York.).. A. E. 62-69.ncsbn..tesc. 109-116.edu:2068/10. K. Healthcare anywhere: The pledge of telehealth. M.. 7-15. & McCormick. (2012). V.edu:2056/ehost/pdfviewer/pdfviewer?sid=e92ab0d8-dc2e-497cb9aa-236e2908dc9f%40sessionmgr198&vid=39&hid=113 NCSBN. (2012). Retrieved from http://persimmon.org/http://persimmon.2012. Morita. & P.1111/j. Shea. Toward an understanding of caring in the context of telenursing..doi. The national council of state boards of nursing position paper on telenursing: A challenge to regulation.tesc. V.00242. Hendricks. 565). Hubbard. Inc.. L. (2012).