SCHOOL OF NURSING SCIENCES AND

RESEARCH
SHARDA UNIVERSITY

NURSING MANAGEMENT

ASSIGNMENT ON
“E- LEARNING , TELEMADICINE ,
TELENURSING”

Submitted to:- Submitted BY:-

Mrs. Neha Barari Ms. Bhawna joshi
Assistant Professor M.sc. Ist year
Obstetric And Gynecological Nursing Deptt. SNSR
SNSR
INTRODUCTION
As we can see technology is and it is going to be the world revolution of any time. Since
scientists, engineers and all kind of people will look for better ways of making life easier and
safer. And the only way to achieve this is with the help of Technology. This science is growing
rapidly and is offering us great advantages to our life. Life is in the hospital industry. We could
see that technology is very important in here because, one of the most important things for the
humanity is our health that is why this industry has to be updated inorder to offer new
discoveries to help people to survive and always be healthy. We can see that we don’t have the
same utensils as before, now we are updated and we have the newest and biggest technology in
medicine.
E –LEARNING/ NURSING
Nurses all around the world have risen to the challenge of new technology. Today, the
nurses work in a variety of E-Health programs such as tele-triage. They access online libraries
and databases of clinical practice guidelines from computers in their work places. Nurse in
specialized areas of practice now interact with their peers in discussion groups over the internet.
Nurses are also involved in standards development for the implementation of electronic health
records and many nursing educational programs are now offered online.
In recent years there has been an explosion in the health care, knowledge globally. Nurses
as the largest group of knowledge workers in health care, must rely on a board range of
information sources and extensive clinical knowledge to support their discussions. In today’s
health care environment, nurses are required to be flexible, innovative and information literate
professionals, able to solve complex client problems by utilizing the best available evidence.
Patient safety is fundamental to nursing care. To provide safe, high quality care, nurses
must integrate new health care knowledge into their practice. Though life – long learning, nurses
must work to maintain their area of practice, they must be able to access information on best
practices from expert nurses and other professionals nationally and internationally. Nurses need
resources to be available 24 hours a day, seven days a week, whenever and wherever they are
working or living. Many nurses practice in remote and isolated regions where accessing needed
information and resources is difficult.
DEFINITION OF E NURSING/ E LEARNING
E nursing involves the use of computers or electronic devices in some way to provide training,
education and learning material
Derek Stockley
E nursing comprises of all forms of electronically supported learning and teaching. The
information and communication system whether networked learning or not, serves a specific
media to implement the nursing process
Tavangarian D et al
E nursing has been defined as the learning and teaching facilitated online through network
technology
Garrison &Andresson
GOAL OF E-NURSING
To enhance nurses to benefit from all developments in information, communication and
technology, to improve nursing and client outcomes.
MODALITIES OF E LEARNING

Individualized self- Individualized self-

paced e-learning online paced e-learning offline

Group-based e-learning Group-based e-learning

synchronously asynchronously

Individualized self-paced e-learning online

It refers when the nurse assess the information online in the Internet. For example a nurse
student is searching for data on some nurse research on the Internet or a local network.
Individualized Self-paced e-learning offline
This refers when an individual nurse learner is using nursing database or a computer-assisted
learning package offline (i.e., while not connected to an Intranet or the Internet). For example a
learner working alone offs a hard drive, a CD or DVD.
Group-based e-learning Synchronously
It refers when groups of nurses are working together in same time through an Internet or the
Internet. For example one or two-way audio and video conferencing.
Group-based e-learning Asynchronously
It refers when groups of nurse are working over an Intranet or the Internet and they exchange
among themselve with a time delay. For example: on-line discussions through e-mailing lists.

LEARNING PREFERENCES AND STYLES IN E-LEARNING

 These comprises of: Offline and online activities, Synchronous and asynchronous activities,
Different multimedia assets. Different didactical interactions, Different ways of delivering the
content, Self study and collaborative learning and Formal and informal learning
Offline and Online Activities
Learning teaching activities takes place while offline i.e. not connected to an Internet and online
i.e. connected to Intranet
Synchronous and Asynchronous Activities
Within synchronous learning, learning and teaching takes place in same time (real time) while
the trainer and learner are physically separated from each other (place shift) e.g. listening to a
live radio broadcast, watching live television broadcast. Audio/video conferencing, internet
telephony, online lectures, two ways live satellite broadcast.
Different Multimedia Assets
The activities are carried out through more than one media.
Different Didactical Interactions
Within e-leaming, different didactical approaches can be used, e.g. assignments, assessment, pre
test, discussions, reading, presenting information, watching a video, asking questions workshop,
demonstration, participating in a simulation, etc.
Different Ways of Delivering the Content
Various ways to deliver the content are computer, PDA, TV, mobile phones, iPod etc. Every
device has its own characteristics, advantage and disadvantages.
Self Study and Collaborative Learning
Learning can be both ways: individualizes as well collaborative in e learning. Formal and
Informal Learning E-learning consists of both informal and formal learning activities. Informal
learning is unstructured, unplanned and formal learning is a learning that is planned with
specified learning objectives. a didactical approach and a planning.

TYPES OR FORMS OF E-LEARNING

Bates and Poole (2003) and the OECD (2005) classified different forms of e learning services as
Fax • E-mail • Knowledge base forum • Computer based training
Asynchronous learning• Quick reference guide • Blogs, wikis and discussion boards

Telephone • Screen sharing • Chat or a skype conversation •

Synchronous learning
 Desktop conferencing • Online Seminar

IMPORTANCE OF E – NURSING
To Organization
 Improve training costs

Producing learning content is time consuming whether it's online Or not but it improves the
overall cost through decreased travel, reduced material, and hopefully improving performance.
 Decrease material costs

By creating the environment online and letting the learner practice, the costs associated with set
up will be negligible.
 Increase productivity

Because e-Learning is not bound by geography or time the learner can enhance their
performance at anytime.
 Standardization

E learning allows creating a standardized process and consistency in delivery time.

To Learners/Employees
 Real-time access

E-learning courses can be accessed anytime, anywhere even without internet access, i.e. On-
demand availability.
 Cost effective

E-Learning is transforming continuing nursing education (CNE) without wasting time and
money for sending them to attend conferences, seminars, etc.
 Interactivity

Interactivity engages nurses, physicians, and other employees motivates them to become active
participants for the learning process, increasing retention and ultimately improving patient and
employee safety and quality.
 Good learning environment

A good learning environment is created with the right feedback.

 Improve retention
The combination of multimedia and instructional design can produce a very rich learning
experience that is repeatable.
 Individualized learning

E-Learning allows to progress with learner's own pace.

To Organization and Community
 Ongoing access to resources

E-Learning gives the opportunity to continue to have access to the online content and resources
to brush up and to update knowledge and skill.
 Knowledge management

E-Learning includes all sort of online technologies that allows collaboration and conversation to
capture organizational knowledge.
 Encourage sharing

Sharing of resources can be encouraged in E-Learning.

 Employer of choice

This allows employers to explore other opportunities in the organization.

THEORETICAL BASES OF E-LEARNING

The main theoretical bases upon which e-learning revolves are andragogy and constructivism.
These theories support the use of e Ivarninq.
Arndragogy
Andragogy is a term refers to the le teaching methodology that best facilitates learning among
adult. The flexibility of anytime anywhere learning allows the learners to develop a learning plan
that fits their needs related to family, vocation, and other areas of life. The dynamic interactions
with other learners can demonstrate relevance as they work together to create new found
meaning.
Constructivism
In constructivism there is flexibility and learning occurs as a result of the learner thinking about
and interacting with the subject matter. It focuses on the concept of knowledge construction
versus knowledge transmission. E-learning is ideal for instructional design that is constructivist
in nature. The learner can construct their own plan for achieving the learning outcomes based on
personal interests.
BENEFITS OF E-LEARNING
 It enhances innovative teaching
 It promotes self-directed and interactive learning
 Convenient for the learner
 E-learning saves time and place for learning
 It enables to enhance data search by hyperlinks
 E-learning aids to learn as and when required
 It promotes internet use
 Build responsibility and self-confidence among learners
 It increases retention and application of information
 Consistent delivery of content is possible with e-learning
 Proof of completion and certification is also automated.

ADVANTAGES OF E-LEARNING
 Identified some advantages of e-Learning are as:
 It increases the flexibility of learning and it is fast and has no geographical barriers
 E-learning technology offers a wide range of opportunities for development of education
 The use of e-learning are independence of time and space and individual can have easy
access
 E-Learning has quality assured programmes
 E-Learning is cost effective in terms of material cost, travelling cost expenditure in
achieving goals
 It is learner centered and provides the learner with information.

DISADVANTAGES OF E-LEARNING
 Some forms of e-Learning perceived as isolating from the personal touch.
 Nurses may not have the IT skills needed to take advantage of e-Learning.

BENEFICIARIES OF E – NURSING
This provides direction over time as new challenges are presented in the health care system
and may need to be revised as developments take place in the electronic environment
surrounding nursing. The beneficiaries are:
o Individual nurses
o Their clients
o Employers
o Nursing professional
o Regulatory organization
o The profession as a whole both nationally and internationally
 TELEMEDICINE

INTRODUCTION
Telemedicine is an upcoming field in health science arising out of the effective fusion of
information and communication technologies (ICT) with medical science having enormous
potential in meeting the challenges of healthcare delivery to rural and remote areas bedsides
several other applications in education, training and management in health sector. It may be as
simple as two health professionals discussing medical problems of a patient and seeking advice
over a simple telephone or as complex as transmission of electronic medical records of clinical
information, diagnostic tests such as E.C.G, radiological images etc. and carrying out real time
interactive medical video conference with the help of IT based hardware and software, video-
conference using broadband telecommunication media provided by satellite and terrestrial
network.Telemedicine is an invaluable tool in Healthcare. Telemedicine allows patients to visit
with physicians live over video for immediate care or capture video/still images and patient data
are stored and sent to physicians for diagnosis and follow-up treatment at a later time.

DEFINITIONS
Telemedicine is a system of healthcare delivery in which physicians examine distant patients
through the use of telecommunications technology.
Preston Jane, 1993
It is defined as 'the delivery of health care services, where distance is a critical factor, by health
care professionals using information and communication technologies for the exchange of valid
information for diagnosis, treatment and prevention of disease and injuries, and for the
continuing education of health-care providers as well as for research and evaluation, all in
interest of advancing the health of individuals and their communities.
WHO, 1997
Telemedicine is the combined use of telecommunications and computer technologies to improve
the efficiency and effectiveness of healthcare services by liberating caregivers from traditional
constraints of place and time and by empowering consumers to make informed choices in a
competitive marketplace.'
Bauer and Ringel, 1999
TELECOMMUNICATIONS
Telecommunication refers to the transmission, emission or reception of data or information, in
the form of signs, signals, writings, images and sounds or any other form, via wire, radio, visual
or other electromagnetic systems.
TELEHEALTH
Telehealth is the 'use of electronic information and tele-communication technologies to support
the long distance clinical health care, patient and professional health related education, public
health and health administration'
. Health Resources and Services Administration (http:// www.hrsa.gotiltelehealth).
Telehealth is the removal of time and distance barriers for the delivery of health care services or
related health care activities. Some of the technologies used in telehealth include: telephones,
computers, interactive video transmissions, direct links to health care instruments, transmission
of images and teleconferencing by telephone or video.
TELEHEALTH CARE
It includes all the health disciplines such as radiology, pharmacy, and psychology.
E-HEALTH
It refers to the use of modern information and communication technologies to meet the needs of
citizens, patients, health care professionals, health care providers, as well as policy makers. It
includes e Care, e Learning, e Surveillance, and e Administration. This definition is officially
adopted the denomination by major international Organizations like, WHO, European Union
(EU), International elecommunication Union (ITU) and European Space Agency.
IsfTeH
International Society for Telernedicine and eHealth established under the Swiss law is dedicated
to promote te.).lemedicine, telecare, telehealth, and eHealth around the world.
mHealth or Mobile Health
Efficient high quality health care services for mobile citizens.
uHealth or Ubiquitous Health Care
This is focusing on eHealth applications that provide health care to people anywhere at any time
using broadband and wireless mobile technologies.
OBJECTIVES OF TELEMEDICINE IN DIFFERENT FORMS
 Information exchange between hospitals and physicians.
 healthcare professionals Networking of group of hospitals, research centers.
 Linking rural health clinics to a central hospital.
 Video conferencing between a patient and doctor, among members of healthcare teams.
 Training of in widely distributed or remote clinical settings.
 Instant access to medical knowledge base, technical papers etc.
TYPES OF TELEMEDICINE
Telemedicine can be broken into three main categories
1. Store- and- forward (asynchronous)
2. Remote monitoring
3. Interactive services (synchronous) (real time)

STORE- AND- FORWARD

 Involves acquiring medical data (medical images, biosignals) and then transmitting this
data to the doctor or medical specialist at a convenient time for assessment offline.
 It does not require both the parties at the same time.
 Medical specialties like dermatology, pathology etc is conducive to this kind.
 Most beneficial for population living in isolated communities and remote regions.

REMOTE MONITORING
 Remote monitoring also known as self- monitoring/ testing.
 It enables medical professionals to monitor a patient remotely using various technological
devices.
 It manages chronic diseases or specific conditions, such as heart disease, diabetes
mellitus or asthma.
 It gives greater satisfaction to patients.
 It is cost-effective.

INTERACTIVE SERVICES
 Interactive telemedicine services provide real-time interactions between patient and
provider.
 It includes phone conversations, online communication and home visits.
 face-to-face visits.
 In “clinician-interactive” telemedicine services may be less costly than in-person clinical
visits.

Many activities such as history review, physical examination, psychiatric evaluations and
ophthalmology assessments can be conducted comparably to those done in traditional
PROCESS AND THE REQUIREMENTS NEEDED
A) Nodal Hospital
A patient getting treated.
A Doctor
A remote telemedicine console having audio visual and data conferencing facilities.
 B) Referral Hospital
An expert / specialized doctor.
A Central telemedicine server having audio visual and date conferencing facility.

THE DATA:-
 Data related to patients personal information.
 Data related to a patients medical information.
 Data of patient management in telemedicine.
 Data related to the doctors.
 Data for system management.

PERSONNEL INVOLVED
Referral end – A group of specialist doctor
System Administrator.
Studio Technician
Nodal end – A group of general physician
System Operator
Data entry Operator
Studio Technician.
DATA RELEATD TO THE DOCTOR
Doctors’ personal information.
Unique identification key.
DATA FOR SYSTEM MANAGEMENT
Users list
Password file
Log files
APPLICATION
 Tele-health care: It is the use of information and communication technology for
prevention, promotion and to provide health care facilities across distance. It can be
divided in the following activities
 Teleconsultation
 Telefollow-up
 Tele-education: Tele-education should be understood as the development of the process
of distance education (regulated or unregulated), based on the use of information and
telecommunication technologies, that make interactive, flexible and accessible learning
possible for any potential recipient.
 Disaster Management: Telemedicine can play an important role to provide health care
facilities to the victims of natural disasters such as earthquake, tsunami, tornado, etc and
 man-made disaster such as war, riots etc. During disaster, most of the terrestrial
communication links either do not work properly or get damaged so a mobile and
portable telemedicine system with satellite connectivity and customized telemedicine
software is ideal for disaster relief.
 Tele-home health care:Telemedicine technology can be applied to provide home health
care to elderly or underserved, homebound patients with chronic illness. It allows home
health care professionals to monitor patients from a central station rather than travelling
to remote areas chronically ill or recuperating patients for routine check-ups. Remote
patient monitoring is less expensive, more time savings, and efficient methodology. Tele-
home care virtual visits might lead to improved home health care quality at reduced costs,
greater patient satisfaction with care, increased access to health care providers and fewer
patients needing transfer to higher, more costly levels of care. A Computer Telephone
Integrated (CTI) system can monitor vital functions of patients twenty four hours a day
and give immediate warnings.

USES OF TELEMEDICINE
o Telemedicine is most beneficial for populations living in isolated communities and
remote regions and is currently being applied in virtually all medical domains. Specialties
that use telemedicine often use a “tele” prefix; for example, telemedicine as applied by
radiologists is called Teleradiology. Similarly telemedicine as applied by cardiologists is
termed as telecardiology etc.
o Telemedicine is also useful as a communication tool between a general practitioner and a
specialist available at a remote location.
o The first interactive telemedicine system, operating over standard telephone lines, for
remotely diagnosing and treating patients requiring cardiac resuscitation (defibrillation)
was developed and marketed by Med Phone Corporation in 1989 in the U.S served as
receiving and treatment centers.
o Monitoring a patient at home using known devices like blood pressure monitors and
transferring the information to a caregiver is a fast growing emerging service. These
remote monitoring solutions have a focus on current high morbidity chronic diseases and
are mainly deployed for the First World, Glucometer.

BARRIER IN TELEMEDICINE
Physician / Patient acceptance:-
It has been found that patients have no difficulty in accepting telemedicine program. A survey
done in Orissa revealed that 90% patients were satisfied with using elemedicine technology. In
almost all the cases the patients are more than happy and satisfied as they don’t have to travel
long distance to show their diagnostic reports to their doctors and also they got the specialist
consultation and their cases has been seen by some expert doctors. Some resistance is seen
amongst doctors. They see telemedicine as an additional duty or workload. Therefore there is a
need to weave telemedicine into the routine duties of the doctors. Some private doctors fear that
telemedicine is likely to reduce their practice. They need to realize that this technology enhances
their reach and exposure and is only likely to increase their practice further.
Availability of technology at a reasonable cost:
There is a myth that establishment of a telemedicine platform is expensive. The basic system
needs hardware, software and the telecommunication link. In all the areas there is a significant
reduction in the price. Most of these costs are well within the reach of most of the hospitals, and
can be recovered by nominal charge to the patient and student in case of tele education.
Accessibility:
Although information technology has reached in all corner of the country but the accessibility of
people living in remote and rural area to the nearest health centre (PHC’s, CHC’s or district
hospital) may not be easy due to poor infrastructure of road and transport. It may be possible that
the available telemedicine system in theses health centered may not function because of the
interruption in power supply / technical problems.
Reliability:
Some healthcare professionals has a doubt about the quality of images transmitted for tele
consultation and tele diagnosis. In tele radiology, tele pathology, tele dermatology the quality of
image (color, resolution, field of view, etc should be of international standard to avoid any wrong
interpretation of data may be of critical importance in tele-mentoring and robotic surgery and
have to be reduced to the minimum.
Lack of trained manpower:
Telemedicine is a new emerging field there I lack of training facilities with regard to application
of telemedicine. Most of the healthcare and IT professionals are not familiar with the program.
Telemedicine is not the part of course curriculum of medical students.
ADVANTAGES OF TELEMEDICINE
 For the patients
 People at remote areas get top class medical facility from reputed
hospitals.
 Reduces travel cost and save time for the rural patients.
 Reduces lot of inconvenience for the rural patients.

 For the hospitals

 Hospitals can spread their reach in remote villages and serve people
without much investment on the infrastructure.
 The hospitals get revenue from the reference made from the remote
locations.
  After care or post operated care patients need not come to the main
hospital for minor consultation.
 Primary diagnosis can be done with the use of telemedicine and patient
can come to the main hospital for major surgery.
 Hospitals can have CME programmes with other hospitals and medical
colleges.
 Hospital can run training programme from their hospitals to doctors of
other hospitals.
 A rare operation or a diagnosis can be broadcast to other hospitals.
 Doctors can learn new techniques by connecting to foreign hospitals.
Overseas consultation and second opinion can be got.
 Job interviews can be conducted.
 Live images like ECG, USG, CT scan, Echo, X-rays and any video output
from medical instruments can be transmitted.
 Screen captures software- use of graphic image.
 Clip art – commonly used in library as graphical image such as computer,
flowers, building, a nurse etc.
 Others
 Animation
 Audio, recording
 Video
 Multimedia application- conferencing, video games.
 Advertisement
 Practicum – invitation preparation, collect data and display in graphic
form.

DISADVANTAGES
 Do rural homes have PC
 Cost of telecom infrastructure
 Lack of standards
 Difficulty in trained users
 Difficulty in maintaining equipments
 Patients confidentiality

INDIAN TELEMEDICINE
 Telepathology India, Dibrugarh
 Apollo Hospitals, Hyderabad
 SankaraNethralaya, Chennai
 Online Telemedicine, Ahmedabad
 NarayanaHrudayalaya, Bangalore
  Medisoft Telemedicine, Ahmedabad
 Heartcare India, New Delhi

TELE NURSING
INTRODUCTION
It refers to the use of telecommunication technology in nursing to enhance patient care and
involves the use of electromagnetic channel (e.g. wire, radio. optical) to transmit voice, data and
video communications signals..This has been used to describe many health care services such as
telemedicine, telehealth, and telenursing etc. The common denominators are distance and
technology. It is in practice, feasible and cost effective in developed countries like Europe, US,
Australia. In Indian scenario, telenursing needs to be considered and should move side by side
with telemedicine. Telenursing — in which nurses deliver, manage, and coordinate patient care
and services via telecommunication technology —is one of the fastest growing areas in
healthcare. In India, telenursing is in infancy stage required to be planned carefully, keeping in
mind the quality of nursing practice. scope for monitoring, and accreditation.
DEFINITION
Telenursing refers to the use of telecommunications and information technology for providing
nursing services in health care whenever a large physical distance exists between the patient and
nurse.'
—Wikipedia.
Telenursing is the delivery of nursing care and services using telecommunications, increases
access to nursing care interventions for clients in remote or distant locations.
—Chaffee, 1999; Helmlinger & Milholland, 1997; Yensen, 1996
Telenursing -is the use of telecommunications technology in nursing to enhance patient care. It
involves the use of electromagnetic channels (e.g. wire, radio, and optical) to transmit voice, data
and video communications signals. It also is defined as distance communications, using electrical
or optical transmissions between humans and/or computers.
—Skiba, DJ, & Barton, AJ, 2000
Types of Telecommunication Tools
There are a variety of telecommunication tools available to the nursing professional today, e.g,
Teleservices, TeIehealth, Tele medicine, Telenursing, Telephone nursing.
Telephone Nursing It is the use of the nursing process to provide care to patients over the
telephone. First used by nurses in the late 1800s.
Teleservices
Care services provided via telecommunication technology transmitting information from one site
to another. This includes telephone consultations, triaging and follow-up.
Telehealth
It is the specific delivery of health care services over distances, utilizing monitors, cameras, and
computers to achieve improved patient outcomes.
Telemedicine
Medicine practiced at a distance, including but not limited to, Teleradiology, telepathology,
telepsychiatry, teledermatology, and teleoncology.
Telenursing Delivery of nursing care and services using telecommunications, a few examples
may include, interactive video, videomonitoring, digital cameras.
Telephone nursing
This has been a reliable source for information to be shared between healthcare providers and
patients. This process provided the building block for other telenursing services.
Tele home care
It incorporates the principles of telehealth into the homecare setting, not specific to the nursing
team.
Tele kid care A telecommunication service for families of children with health issues.
REQUIREMENTS FOR TELENURSING
1 . Hardware
Telephone :The telehealth system is used via the patient's telephone system. A working phone
must be available. The monitor is plugged directly into the phone and the phone is directed
through the monitor so phone service is not interrupted.
Telehealth hardware :The telehealth equipment consists of a monitor, electronic blood pressure
cuff, pulse oximeter, scale, there is also EKG leads, video camera, blood glucose, and peak flows
capabilities. Many companies are designing wireless versions of these pieces of equipment, this
allows for ease of use and convenience for placement in a patient's home.
PC or laptop computer :The nurse must have access to a PC or laptop, with internet service
available to access the patient data once it has been transmitted to the secure data base. A power
source is needed such as wall outlet.
Power supply and Web access
2. For Tele health Monitoring
Depending on the needs of the patient the monitor should • Have vital sign measurement
capabilities, pulse oximeter readings, glucose measurements and peak flows readings can be
manually typed into the monitor .Each monitor can be programmed to provide personalized
communications with the patient. The monitor should be compact, light weight and portable. The
readings of monitor should easy to read, large print can be provided, some are voice prompted,
the monitors are easy to use, and user friendly.
3. Software
The following are the software used in telehealth:
Operating system-Linux, National database. Security technology and firewalls and Rewritable
flash memory. Operating system-Linux Once the patient data is obtained it is sent to a secure
web site. One operating system that is used by Telehealth companies is the Linux system. This is
an operating system such as windows XP; this is a free operating system that is accessible to
anyone.
National database A national data base system that uses technology to ensure compliance and
privacy standards is used. The nurse must have a user password to access the data. Patient
information is stored at the data base and can be accessed at any time by the nurse or physician
via the web site. Patient trending is also available.
Flash drive Data can be stored on a flash drive and transport by the patient to hospital. Once the
patient is no longer using the system the monitor is reprogrammed via the data base by the nurse.
Firewalls and other security devices These are used to provide security and prevent
information theft. The top monitor is for multiple patient uses and the bottom monitor is for
individual use.The patient would use the monitor as instructed by the nurse, the information is
then sent via the POTS (plain old telephone system) through the router and firewalls (set-up for
protection) to the Internet servers, flowing to the application server then secured in the database.
As demonstrated the nurse would then access the information using her knowledge of computers
and the Internet.
4. Software programmes
Cerner software a widely used software program by many health care facilities

APPLICATION OF TELENURSING
Telephone consultation
E mail enquires
Distance learningvideo monitoring
Digital photography

BENEFITS OF TELE NURSIG

 Enhance patient care
 Reduce travel time
 Increase productivity
 Access to specialties
  Enlarged educational opportunities

USES OF TELE NURSING

 Home care agencies
 Hospices
 Hospital based telemedicine center
 Managed care center
 Rehabilitation center
 All branches of military

EVIDENCE BASED USES OF TELE NURSING

In medical surgical conditions
 For patients who are immobilized, or live in remote or difficult to reach places, citizens
elderly, children and adults with chronically conditions and debilitating illnesses such as
chronic obstructive pulmonary disease, diabetes, congestive heart disease, neural
degenerative diseases, etc.
 Care of patients in immediate post-surgical situations, having wounds, ostomies, etc.
 Nursing intervention to support mothers with difficult infants, reduces fatigue and
distress.
 Allow women with pregnancy-induced hypertension to remain at home.

Monitoring
 Home monitoring of physiologic parameters, such as blood pressure, blood glucose,
respiratory peak flow, and weight measurement, taking a pulse oximeter reading, and
visually assess via the Internet and telephone from a base station.
 Enables nurses to provide accurate and timely information and support online
 Examination of test results
 Monitoring of Daily Life and Symptoms for Home Oxygen Therapy Clients.

Self Management
 Helps patients and families to be active participants in care, particularly in the chronic
illness, changing of dressing, giving insulin injection

Cost Effective
 Reduces the requirement for, or the length of, hospital stay of patients and saves nurses
time.

Professional education
  Helps to sharing Clinical information with national and international experts.
 Increases access to nurse education, particularly for continuing education.
 Clinical skills can be learned and practiced through patient siniulation modeling
 Offers a doctorate in nursing completely via online distance education.
 Provides opportunities for senior nurses to bring their years of experience back to the
clinic,
 Allows a nursing student to have contact with a clinical data repository, a faculty
supervisor, and the Web,
 To disseminate educational and other materials by using Web. Increase satisfaction
among nurses by creating more collaborative and autonomous roles.

IMPLICATIONS OF TELENURSING
Delivery, management, Coordination of Care
 Nursing knowledge and processes are used to provide care to patients in many
geographic areas.

Multi-disciplinary Teams
 A multi-disciplinary team can use many technologies available to view and share patient
information providing prompt and effective care.

Disease Management
 Nursing care and the new innovative technologies can play a vital role in disease
management, and improving patient outcomes through Distant Care.

OBSTACLES IN TELENURSING
The implementation of telenursing may encounter following problems:
 Patients and their family members may not be able to use home based equipment. Many
patients may be having fear to use it
 Acceptance by patients who prefer to see health care providers face-to-face
 Initial cost outlay may be very high
 Privacy is an ongoing concern
 Security of data is questionable
 May be difficult to track and proves for reimbursing providers.

DISADVANTAGES OF TELENURSING
Dehumanizing Effects
 There are healthcare professionals who feel the telehealth system has dehumanizating
effects. Without the human touch how is the nurse able to do a thorough assessment
Cost
 Telenursing is quite costly due to the cost of the monitor and equipment.

Inability for Patient to Use Equipment

 Many patients threatened to use electronic equipment and may not like to use.

Knowledge Base of the Nurse

 Because telehealth, is often based on limited interaction physically with the patient and
data is collected via monitors, knowledge of the nurse and her clinical competence is vital
in the appropriate interpretation of the patient .

Equipment malfunction
 Malfunctioning of the equipment may create problem to the patients In telenursing. The
system can only be used if equipments are working properly

PROBLEMS IN IMPLEMENTING TELE MEDICINE

 Understanding of software
 System error
 Patient understanding
 Cost

ISSUES IN TELENURSING
 Societal
 Technical
 Safty standards
 Regulatory issues
 Professional liability
 Egal issues
 Reimbursement

TELENURSING PRACTICE STANDARDS BASES

The bases for nursing practice standard should be in consistent with:
 INC practice standards
 Code of ethics
 State registration Act
 Clinical protocols

GUIDELINES
There should be practice standards guidelines
 To address the quality of care issues for providing the nursing services through distance.
 Practice standards guidelines should be directed to promote safe, competent and ethical
nursing practice and in term of structure, process and outcome with indicators.
 Telenurse should have special license, specially trained for Telenursing.
 There should also be a provision for continuing education to update their level of
performance. Telenursing Practice standard guidelines should be within the competency
framework
 .The core competencies related to technology, proper working of equipments,
clinical/technical, education and knowledge and code of ethics are required to be defined
for the telenurse.
 Policies for the safe and ethical Telenursing practice need to be focused on
accountability, client choice regarding, informed consent to treatment/care, seat-liability,
and confidentiality and privacy.

.
CONCLUSION

 The future of e-learning E-learning is not just a change of technology. It is part

of a redefinition of how we as a species transmit knowledge, skills, and values to
younger generations of workers and students.
 Telemedicine will soon be just another way to see a health care professional, just
as seeing friends and family. Technology manufactures and telecommunication
companies are already flying each other to produce low cost equipments and
bandwidth needed. Telemedicine is a boon to our medical field which help he
rural population the physician and even the government in maintaining and
promoting the health care of the nation.
 Telenursing is a valuable asset in the nursing field. The technology helps not
only to improve the quality of health services but also minimize medical cost.
Nevertheless, lack of mechanisms to warrant the privacy of the patient and the
inability to handle the challenge of integrity thwart the use of telenursing systems.

SUMMARY
 E-learning is a collective name for a number of channels through which knowledge
can be distributed. Three basic principles create the base for e-learning. First, it is
networked. Second, users convey it via the Internet. And third, it puts the spotlight on
learning in the broadest sense
  TELEMEDICINE Providing care to patients/clients through the use of communication
equipment is not really new. It is only becoming more popular or used because of
advancements in the telecommunication industry.

 Telehealth nursing involves the use of telecommunications technology (video, phone,

email, text messaging, and other digital platforms) to provide nursing care to remote
patients, as well as services like medical transcription and case management to doctors,
hospital administrators, and other nurses.

BIBLIOGRAPHY
Books
1. Joginder Vati. Principles and practice of Nursing Management and administration. 1 st
edition. Jaypee publishers. Page no – 664- 678
2. Tabish S. A. Hospital and Nursing Home Planning, Organization and Management. New
Delhi. Jaypee brothers medical publishers, 2003. Page no: 213- 220.

Website
1. www. nursing world. com
2. www. indian journals. com
3. www. discovery computers.com