Tele-nursing an Emerging Innovation in Health Sector

Dr. Sandhya Ghai, Geetanjli Kalyan.

Limited access to health care services, difficult admissions, early discharges from hospitals and long cues
of out patient departments have increased the need of a kind of health care service which can be
accessed form home or from remote areas. To meet this need of the hour an innovative cost effective
health care modality came into existence which is known as telemedicine. The word telemedicine came
form the Greek word telos, which implies distance. This concept might have been originated centuries
ago but the current system of telemedicine was first used in 1960 by National Aeronautics and Space
Administration (NASA). The Physiological measurements of the astronauts were telemetered both from
the spacecraft and the space units. The sophisticated telemetry and telecommunication systems were
developed by the scientists(1). Presently the telemedicine has expanded rapidly and many disciplines
render services through it. In addition to other telemedicine related services, nursing services can also be
provided through distance. The delivery of nursing service with communication technology through
distance is called as telenursing(2). This field of health care is not so very well established all over the
world, but is a vary valuable innovative method of providing nursing care especially in home health care(3).

Telenursing is defined as the “use of telecommunication technology to deliver nursing services to client at
a distance”. It combines information technology to render nursing services to clients at geographically
distant locations (4). The American Nurses Association has defined “telenursing as a subset of telehealth
in which the focus is on the specific profession’s practice (i.e., nursing)” (5). Nurses’ use technologies such
as the Internet, computers, telephones, digital assessment tools, and telemonitoring equipment in their
practice to assess, plan, intervene, and evaluate the outcomes of nursing care. This technique has
expanded the scope of nursing practice across the states and international borders and it is also
changing the face of standard nursing practice (4, 6). This is now a upcoming carrier option for the nurses of
21st century(7). In America 40% home services are teleheath based. It is believed that in United States half
of nurses home visits are replaced by telenursing (8). In developing countries where there is shortage of
nursing, this innovation can play a vital role in patient care and they will able to access nursing services
sitting at their home.

Telenursing has been used successfully in many activities which include:

Providing community services like home based care/ outreach services. If the nurses are
provided with adequate education for their role, full technological facilities, decision support
software, ready access to supervision and continuing education they can deliver services safely.
The Child and Adolescent Psychological Telemedicine Outreach Service (CAPTOS), geriatric
outreach services, rural clinics, care of patients having chronic illness at their home are some of
the examples.(6, 9-22) Cable television-based interactive video system, repeated telephone calls for
education and follow up, electronic transmission of patient’s record, and interactive websites are
use to deliver services at home. Nurses’ advices are based on the nursing tele-assessment,
diagnosis and management protocols.
Assessment of conditions and triage: assessment of client on telephone and triage; use of
interactive videos and entering appropriate data into the software are helpful. It is always helpful
to ask relevant open ended questions. (23-27)
 Care of school children: self care abilities among school children can be increased with this
intelligent technology. Many children can be educated at same time. (28-29)
Palliative care: NurseLine with the expertise of specialized community-based palliative care
services, with a commercially available video-phone connected with the client s home telephone
line. A hands-free speaker-phone and a miniature video-camera (for close-up views) can be
connected to the video-phone which can be used to provide emotional and informational support.
(12, 15, 30)

Management of patients is done by relaying their vital information (vital signs, ECG report) to
the telenursing center. Patents having heart failure and related problems/pulmonary diseases,
depression, chronic conditions like diabetes, stoke, chronic obstructive pulmonary disease have
been successfully managed by telenursing. (13, 17, 29, 31-44) Pain and fluid management can also be
done and the good example of this is care of pediatric client after tonsillectomy. (11, 30, 45-47) . Nurses
have also addressed the problems of menopausal women, patients having ostomy and wounds
through telenursing.(48-50)
Telenursing in ICU: The nurses working in ICU can get instruction for the care of patient through
interactive videoconferencing and manipulating sensors. The nurse can also get nursing care
protocols which are evidenced based form the nurses working at level I hospitals. (51)
Suicide and HIV/AIDS patients help lines have also been established in many countries. Such
lines are operated by psychiatry and medicine departments of PGIMER Chandigarh, India.
Education:
Teaching the skills and continuing education which is basic to evidenced based nursing care can
be carried out by videoconferencing. This technology has also been used to teach nursing
students the care of patients in community through simulation (52). Nurses have also used
telenursing to get ICU care guidelines. (53) Webinars and mobile apps on essential new born care
nursing developed by WHO newborn care center AIIMS, have been effectively used to educate
nurses/ nursing students in India. (54) Indian Nursing council is also using it for sessions of expert
faculty and research protocol presentations of Ph.D nursing students. Telenursing center has also
been established at Mysore based Vishwabharati school and college of nursing. The nurses of
Nepal and Afganistan have also been educated through the telemedicine center of PGIMER,
Chandigarh.

Benefits of telenursing to nurses:

Improved salary, and flexible working hours: Nurses if work from home they will feel at ease
to work flexibly. They can earn more by working for more hours and providing services to many
patients at a same time with in short period of time.(9, 55)
Less travel and Cost-effective for nurses: The travel expense of nurses has been curtailed to
zero as they provide services from their home and they are able save money.
Easy to provide remote services: This innovative technique has made it is easy to
provide services to people living at far flung areas. (6, 9-22, 56)
Improved job satisfaction and opportunities for skill development: Nurses working from
home feel that they are more productive, have to take fewer sick leaves and their employer also
reported that there is lower attrition rate. This is how this new innovative technology has
increased the satisfaction among nurses with their new roles. The nurses also feel satisfied with
the specific knowledge and skills used by them to deliver telenursing services and the settings in
which they learn such skills, and competencies. (55, 57)
 New carrier option: The growing population has overloaded the hospitals, so the need for home
based care has increased. The nurses are also willing to opt for a job where they can earn more
and have more satisfaction. (7)
Data sharing: Through use of internet and web based interface now it is easy for nurses to share
data/get guidelines form different settings.
Rapid response time: Nurses can respond with in a minute if technology is in a well working
condition. This is helpful for the patients having suicide tendencies. These patients can seek rapid
help form suicide help lines.

Benefits to patients
The population living in remote areas can obtain health care at their destinations if they have internet
facilities on their phones/computers similarly the travellers can also get services at their home (6, 9-22),
(58-59)
. Easy access to high quality care at minimized cost is available to patients as they are not
supposed to travel to distant location nor are supposed to stand in long cues to get the services. This
is how the prompt care makes the clients more satisfied. (3)

Competency, Qualifications and Skills required

To be a telenurse the nurse must have a positive attitude, open-mindedness, knowledge and
ability to navigate the technology and understand its limitation. The nurse should be able to
assess the need for hospitalization and need of change in the care plan. No service can be
delivered effectively with out a competent communication skill because it a must to assess and
triage the client. The telecommunication requires a frequent use of technology. The nurses must
be technology friendly and must have an appropriate video/telephone behavior. The consumers
of services can be saved only with evidence based information and care, so the nurses must
have continuous update.
They must possess a skill to deliver competent nursing services through the technology. (59) The
Interstate Licensure is must because the services can’t be restricted to one state only.

Problems / Issues related to telenursing

Difficulty in using technology due to lack of instructions, education, lack of help and support can
be a big problem both for nurses and clients. (39) We can face failure of technology, threat to
safety of patient, and malpractice(60-62) . To ensure client’s conversation to a registered nurse is big
ethical issue. Disrespect in dialogue with female nurses and difficulties faced while talking to male
clients is another challenge(63). Ensuring confidentiality and informed consent is also problematic
in telenursing. The invasion of privacy can also be a problem due fitting of cameras at home. We
can’t ensure that these services can be accessed by disadvantaged groups.(55).

The way forward

The majority of studies that were reviewed showed that the benefits of telenursing and its use has
been established to benefit patient and nursing students in many countries, whereas through out review
literature we could hardly find use of telenursing in Indian settings. Here it is only used to assess
effectiveness of webinars on learning of nursing students on essential new born care and used by Indian
Nursing Council for the Ph.D program. (54) Keeping in view the benefit of telenursing we look forward to
establish a telenursing center at National Institute of nursing Education (which is attached to a national
level teaching and training tertiary level care hospital) and we intend to use it for patient and nursing
education programs. We also look forward to establish collaboration with international nurses through
telenursing so that our nurses can be trained and educated for its use and practice.

Conclusion
The telenursing is cost-effective and time saving innovative technology. It has expanded very fast over
last few years and will continue to expand. It will be excellent carrier option for the nurses of 21 st century.
The nurses need to posses adequate competencies, technology friendly attitude and ways to ensure
patient safety so that its safe use can be established world wide. Nurses always need to ensure that they
should not go beyond the scope of nursing practice.

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NAMA: ASYRAF HASBUL WAFI
KELAS: A1
NIM: 005STYC19

Jadi Kesimpulan saya

Telenursing didefinisikan sebagai "penggunaan teknologi telekomunikasi untuk

memberikan layanan keperawatan kepada klien dari jarak jauh". Ini menggabungkan
teknologi informasi untuk memberikan layanan keperawatan kepada klien di lokasi yang
jauh secara geografis.American Nurses Association telah mendefinisikan "telenursing
sebagai bagian dari telehealth di mana fokusnya adalah pada praktik profesi tertentu (yaitu,
keperawatan)".
Perawat menggunakan teknologi seperti Internet, komputer, telepon, alat penilaian
digital, dan peralatan telemonitoring dalam praktik mereka untuk menilai, merencanakan,
mengintervensi, dan mengevaluasi hasil asuhan keperawatan. Teknik ini telah memperluas
ruang lingkup praktik keperawatan di seluruh negara bagian dan perbatasan internasional dan
juga mengubah wajah praktik keperawatan.
Di Amerika, 40% layanan rumah tangga berbasis teleheath. Dipercaya bahwa di
Amerika Serikat setengah dari kunjungan rumah perawat digantikan oleh telenursing. Di
negara berkembang di mana terdapat kekurangan perawatan, inovasi ini dapat memainkan
peran penting dalam perawatan pasien dan mereka akan dapat mengakses layanan
keperawatan yang ada di rumah mereka.

Telenursing telah berhasil digunakan dalam banyak aktivitas yang meliputi:

1. Memberikan layanan masyarakat
2. Penilaian kondisi dan triase
3. Perawatan anak sekolah
4. Perawatan paliatif
5. Manajemen pasien
6. Telenursing di ICU
7. Saluran bantuan untuk pasien bunuh diri dan HIV / AIDS
 8. Pendidikan:
Manfaat telenursing bagi perawat:
1. Gaji meningkat, dan jam kerja fleksibel
2. Perjalanan lebih sedikit dan hemat biaya untuk perawat
3. Mudah untuk menyediakan layanan jarak jauh
4. Peningkatan kepuasan kerja dan peluang untuk pengembangan keterampilan
5. Opsi operator baru
6. Berbagi data
7. Waktu respons yang cepat
Manfaat bagi pasien:
Penduduk yang tinggal di daerah terpencil dapat memperoleh layanan kesehatan di
tempat tujuan jika memiliki fasilitas internet di ponsel / komputernya demikian pula para
pemudik juga dapat memperoleh layanan di rumah. Akses mudah ke perawatan berkualitas
tinggi dengan biaya minimal tersedia bagi pasien karena mereka tidak boleh melakukan
perjalanan ke lokasi yang jauh atau harus menunggu lama untuk mendapatkan layanan.
Beginilah cara perawatan yang tepat membuat klien lebih puas.

Kompetensi, Kualifikasi dan Keterampilan yang dibutuhkan:

Untuk menjadi telenurse perawat harus memiliki sikap yang positif, keterbukaan
pikiran, pengetahuan dan kemampuan untuk menavigasi teknologi dan memahami
keterbatasannya. Perawat harus dapat menilai kebutuhan rawat inap dan kebutuhan
perubahan dalam rencana perawatan. Tidak ada layanan yang dapat diberikan secara efektif
tanpa keterampilan komunikasi yang kompeten karena itu suatu keharusan untuk menilai dan
menentukan prioritas klien. Telekomunikasi membutuhkan penggunaan teknologi yang
sering. Perawat harus ramah teknologi dan harus memiliki perilaku video / telepon yang
sesuai. Konsumen layanan dapat diselamatkan hanya dengan informasi dan perawatan
berbasis bukti, sehingga perawat harus memiliki pembaruan terus menerus. Mereka harus
memiliki keterampilan untuk memberikan layanan keperawatan yang kompeten melalui
teknologi.
Lisensi Antar Negara harus karena layanan tersebut tidak dapat dibatasi hanya
untuk satu negara bagian.

Masalah / Isu terkait telenursing:

Kesulitan dalam menggunakan teknologi karena kurangnya instruksi, pendidikan, kurangnya
bantuan dan dukungan dapat menjadi masalah besar baik bagi perawat maupun klien. Kita
dapat menghadapi kegagalan teknologi, ancaman terhadap keselamatan pasien, dan
malpraktek. Untuk memastikan percakapan klien dengan perawat terdaftar adalah masalah
etika yang besar. Tidak hormat dalam dialog dengan perawat wanita dan kesulitan yang
dihadapi saat berbicara dengan klien pria adalah tantangan lain. Memastikan kerahasiaan dan
persetujuan yang diinformasikan juga bermasalah dalam telenursing. Pelanggaran privasi
juga bisa menjadi masalah karena pemasangan kamera di rumah. Kami tidak dapat
memastikan bahwa layanan ini dapat diakses oleh kelompok yang kurang beruntung.

Kesimpulan
Telenursing adalah teknologi inovatif yang hemat biaya dan waktu. Ini telah
berkembang sangat cepat selama beberapa tahun terakhir dan akan terus berkembang. Ini
akan menjadi pilihan karier yang sangat baik untuk perawat abad ke-21. Perawat perlu
memiliki kompetensi yang memadai, sikap ramah teknologi dan cara-cara untuk memastikan
keselamatan pasien sehingga penggunaan yang aman dapat diterapkan di seluruh dunia.
Perawat selalu perlu memastikan bahwa mereka tidak boleh melampaui ruang lingkup praktik
keperawatan.