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TELENURSING IN
NURSING PAPER

By:
RIDO ADRIAN SAPUTRA
NIM. 160101019

Supervisor:
????

BACHELOR OF NURSING STUDY

PROGRAMME STIKES PIALA SAKTI
PARIAMAN
2020
 FOREWORD

Praise be to Allah SWT, for only by His grace and mercy can we complete this
paper on time.
On this occasion, we would like to thank the lecturer of the Introduction to
Nursing Profession course so that this paper was completed on time. We would also
like to thank our friends for all their help and support.
We realise this paper is far from perfect. Therefore, we expect constructive
criticism and suggestions for this paper. Finally, we hope that this paper can be
useful for all of us. Amen.

Pariaman, June 2020

Author
 TABLE OF CONTENTS

Foreword ................................................................................................ 1
Table of Contents .......................................................................................................... 2
CHAPTER I
Introduction .............................................................................................................3
a. Background .............................................................................. 3
b. Problem Formulation ........................................................................ 4
c. Destination ........................................................................................... 5
CHAP
TER II
Contents
A. Definition Telenursing
............................................................................... 6
B. Principles of Telenursing..................................................................................7
C. Telenursing App...............................................................................................7
D. Benefits of Telenursing...................................................................................11
E. Disadvantages of Telenursing ........................................................................13
F. Research on Telenursing ................................................................................14
G. Obstacles to Telenursing Application and How to Overcome Them........16

CHAPTER III
Cover ................................................................................................... 20
Bibliography .........................................................................................................................22
 CHAPTER I
INTRODUCTION

A. Background.
In recent years the nursing profession has experienced rapid development.
This is due to the influence of globalisation where the public demands the nursing
profession to improve itself. The most basic and most challenging demands are
regarding professional, quality nursing services and can be reached by the
community.

Nurses are increasingly required to be professional and prioritise the

development of health technology, where patients/clients who need care are in need.
Nursing can come from all walks of life and in the "cyberspace" (cybernet), which is
increasingly characterised by the high number of internet users in Indonesia, and the
growing number of websites in the health sector.
The rapid development of science and technology in the fields of education
and health, including nursing services, has encouraged the creation of a model of
distance nursing services, better known as telenursing.
Telenursing occurs when nurses discover the health needs of clients through
assessment, triage and information provision, using information, communication and
network-based systems. Telenursing facilitates access to health care with respect to
under-serviced populations and remote areas as well as facilitating monitoring of
home care or individuals with chronic health problems.
Telenursing has been successful in high-growth countries due to several
factors, including savings in healthcare costs, an increase in rates of

ageing and the population with chronic diseases and improving health coverage
long-distance, rural and remote areas. Telenursing can help solve the shortage of
nurses, decrease the distance, visit time and keep patients who have been discharged
from the hospital.
Health services, especially long-distance nursing using information
technology media (internet), provide convenience for the community. People or
patients do not need to come to the hospital, doctor or nurse to get health services.
The time required for health services is also getting shorter. Patients can just stay at
home and make contact via the internet or through video converence to get health
information, care and even treatment.
Indonesia as a developing country with a very large population

The large and dispersed area is a potential in applying telenursing in order to

improve nursing and public health services for the community.
support the achievement of the vision of a healthy Indonesia 2010. For this reason,
we will discuss telenursing in an effort to improve the role of Indonesian nurses in
facing Healthy Indonesia 2010 through the field of health informatics.

B. Problem Formulation
The problem formulation of our paper is:
1. What is telenursing?
2. How does telenursing apply to people's lives?
3. What are the benefits of telenursing applications in people's lives?
4. Is there any research on telenursing in nursing care?
5. What are the inhibiting factors in the application of telenursing in society and
how can they be overcome?
C. Destination
1. General Purpose
Provide an explanation of telenursing
2. Specific purpose
a. Explain the definition of telenursing
b. Explain the principles of telenursing
c. Explaining the benefits of telenursing
d. Explaining the shortcomings of telenursing
e. Explain telenursing applications
f. Explain telenursing research

g. Explain the factors that hinder telenursing and how to overcome them
 CHAPTER II
LITERATURE REVIEW

A. Definition of Telenursing
There are several definitions of telenursing, namely:
1. Telenursing is the use of communication technology in nursing to fulfil nursing
care to clients. It uses electromagnetic channels (magnetic, radio and optical
waves) in transmitting voice, data and video communication signals. Or it can
also be defined as long-distance communication, using electrical and optical
transmission, between people and/or computers.

2. Telenursing is the delivery of service and care by nurses using

telecommunications, improving access to nursing care.
to patients at distant or remote locations.
3. Telenursing is the use of information technology to provide nursing care in
health care settings where there is a physical distance between a nurse and a
patient, or between multiple nurses. It is a part of telehealth and some parts are
related to medical and non-medical applications such as telediagnosis,
teleconsultation and telemonitoring.
4. Telenursing refers to the use of communication technology by nurses to improve
patient care. Telenursing uses electromagnetic channels (wire, radio, optical) to
send voice, data and video communication signals. It can also be defined as long-
distance communication using electrical or optical transmission between humans
and/or computers.
5. Telenursing is defined as the use of telecommunications to provide nursing
information and services at a distance. Current applications utilise satellite
technology to broadcast consultations between healthcare facilities in two
countries and use video conferencing equipment.

Telenursing is an integral part of telemedicine or telehealth.

6. Telenursing is the use of information technology to provide nursing care in
health care settings where there is a physical distance between a nurse and a
patient, or between multiple nurses. It is part of telehealth, and some parts are
related to medical and non-medical applications, such as telediagnosis,
teleconsultation and telemonitoring.
7. Telenursing is defined as the practice of nursing over distance using
telecommunications technology (National Council of State Boards of Nursing).
Telenursing is defined as the use of telecommunications to provide nursing
information and services at a distance. Its current application uses satellite
technology to broadcast consultations between facilities.

health facilities in two countries and utilised video conferencing equipment (an
integral part of telemedicine or telehealth).

B. Principles of telenursing
The principles of telenursing are: it does not change the nature of nursing
care practice, where nurses are involved in telenursing from assessment, planning,
implementation, evaluation and documentation of nursing care. Nurses also engage
in personalised information, education, direction and support in telenursing
relationships established through the use of telephone, computer, internet or other
communication technologies.

C. Telenursing App
Telenursing applications can be applied at home, hospitals through
telenursing centres and through mobile units. Telephone triage and home care are
rapidly growing in telenursing applications. In home care, nurses use a system to
monitor physiological parameters such as blood pressure, blood glucose, respiration
and weight via the internet. In patient care at home, the nurse can

monitor the patient's vital signs such as blood pressure, blood sugar, w eight,
the patient's peak respiratory flow via the internet. By video conferencing, patients
can consult on wound care, insulin injection and shortness of breath management.
Through the interactive video system, patients contact on-call nurses at any time to
arrange video consultations to address problems, for example how to change clothes,
give insulin injections or discuss shortness of breath. It is especially helpful for
young children and adults with chronic diseases and frailty, especially with
cardiopulmonary diseases.
Telenursing helps patients and families to actively participate in care,
especially in chronic disease management. It also encourages nurses to prepare
accurate information and provide support online. Continuity of care can be improved
by encouraging frequent contact between the patient and family.

health and nursing care providers with individual patients and their families.
Telenursing media include:
1. Telephone (mobile phone)
2. Personal Digital System (PDA)
3. Facsimile machine (fax)
4. Internet
5. Video or audio conferencing
6. Teleradiologist
7. Computer information systems
8. Teleborotic
Another practice guideline that uses telenursing is :
1. Relay important client information such as electrocardiogram data, CT scans, x-
rays, etc.
2. Using video, computer to monitor client's health condition.
3. Monitor the client's health status in hospital or home e.g. blood pressure,
respiratory pulse, temperature etc.
4. Assist travellers to obtain healthcare at their destination.
5. Assist client operations remotely.
6. Using video conferencing to provide continuing nursing education sessions.
7. Develop a website to provide health information and counselling times.
Ultimately, telenursing can increase the active participation of patients and
families, especially in the personal management of chronic diseases. It can provide
accurate, fast service and online support, continuous care and unlimited contact
between carers and patients.

The practice of telenursing in Indonesia is not as developed as in developed

countries such as America or Australia. Use of
telenursing in Indonesia is still limited to the education area as developed at UGM
through e-learning programme or e-lisa model integrated in all faculties of UGM and
some other private universities.
Recently in Indonesia, there are organisations engaged in home care services.
Home care in Indonesia has not yet used the Telenursing system, but it is still a
home visit, meaning that nurses visit patients' homes for direct care without using
sophisticated technology services. The media used is still limited to the use of
telephone media as a call centre. Even then, it is still limited to big cities, district
cities have not been touched by home care services.
This model of nursing care (home care) can actually be regarded as a
telenursing service even though it is very simple. At least professional organisations
can immediately establish the concept of developing tele-care services by developing
Home Care which has already begun to run by increasing the scope of services to the
regions and eventually
we can really develop our services through the use of more advanced technological
facilities.
What needs to be prepared in the legality of remote health or nursing services
in this case the use of telenursing or telemedicine in hospitals carried out by health
agencies such as nurses, doctors, and others is where nurses use knowledge, skills,
judgement, and critical thinking that cannot be separated in the science of nursing
education. Such activities can already be licensed to perform nursing care.
Therefore, the application of telenursing in providing nursing services will
increase client satisfaction and increase active participation.

family. In providing nursing care remotely, a general policy from the government is
needed to regulate practice, SOPs/operational standards
procedures, ethics and professionalism, safety, patient confidentiality and assurance
of information provided. Telenursing activities require integration between strategies
and policies to develop nursing practice, the provision of nursing care services, and
nursing education and training systems.
To be applied, there are several things that need to be considered:
1. Legality factor
It can be defined as the autonomy of the nursing profession or nursing
institutions that have responsibility for the implementation of telenursing.
2. Financial factors
The implementation of telenursing requires a considerable amount of money
because the facilities and infrastructure are very large. Support is needed from the
government and professional organisations in providing the financial aspects of
telenursing implementation.

3. Skill Factor
There are two aspects that need to be considered, namely knowledge and

skills about telenursing. Nurses and patients need to be trained on the application of
telenursing. The implementation of telenursing is highly dependent on the
knowledge and skill aspects between patients and nurses. Knowledge of telenursing
must be based on information technology knowledge.
4. Motivational Factors
Motivation of nurses and patients is a top priority in the implementation of
telenursing. Without motivation from nurses and patients, telenursing will not work
well.

D. Benefits of Telenursing
Many benefits when we use technologyin tele-nursing
services include:

a. Reduced waiting time and fewer unnecessary visits.

b. Shorten treatment days and reduce treatment costs
c. Help fulfil health needs.
d. Facilitate access to health workers in isolated areas.
e. Useful in chronic or geriatric cases that require home care at a distance from
health services.
f. Encourage health workers or underserved areas to access providers through
mechanisms such as: video conferencing and the internet (American Nurse
Association, 1999).
In addition, electronic telecommunication is the best access to educational
opportunities, new methods of documentation, increased access to information,
developing decision-making skills that can help make changes in the
professionalisation of nurses.
According to Britton, Keehner, Still & Walden 1999 there are several
advantages of telenursing:
1. Effective and efficient in terms of health costs, patients and families can reduce
visits to health services (doctor's o f f i c e , emergency room, etc.).

emergency, hospital and nursing home)

2. With minimal resources, it is possible to increase the scope and reach of nursing
services without geographical boundaries.
3. Telenursing can reduce the number of visits and days in hospital
4. Improved care for chronic patients, at no cost and increased utilisation of
technology
5. It can be utilised in the field of nursing education (distance learning model) and
the development of health informatics-based nursing research. Telenursing can
also be used in on-campus learning, video conferencing, online learning and
multimedia distance learning. Nursing clinical skills can be learnt and practised
through interactive simulation models.

In addition, telenursing can provide opportunities for nurses with clinical

experience who have retired/are no longer working in health care,
but can still provide nursing care online. It also avoids direct contact, minimises the
risk of nosocomial infections, and provides privacy of space and time for patients
and nurses. It can be imagined that patients with HIV/AIDS, or patients who use
drugs/alcoholic drugs will feel more private with this telenursing service.
According to Ian St. George (2007), there are several advantages of
telenursing, namely: For Employers:
a. Workplace cost savings, office fees, parking fees
b. Increased productivity
c. Increased motivation, employees respond well to signals of trust and
confidence
d. Retention skills; employees can be retained despite family issues, e.g. family
illness, family crisis, pregnancy and caring for young children; work fewer
absences.
e. The organisation is flexible, in the event of restructuring it can continue to

work without interruption.

 f. Flexible staffing; staffing levels can reflect workload without the need to
relocate/travel.
g. Resilience; transport disruptions do not cause delays or absenteeism.
For Employees:
a. Reduced travelling time and costs, greater personal safety, lower costs for
office uniforms and maintenance.
b. Employment opportunities are not only limited to nursing jobs.
c. Reduced disruption to family life; reduced need for relocation to take up job
changes.
d. Better work-life balance and better family life.

e. Participation in the local community is higher even though we are working.

f. More flexible working
hours. For the Community:
a. Reduce traffic congestion
b. Reduce the number of trips and with thus
pollution is also reduced

E. Disadvantages of telenursing
The concern with telenursing is that the absence of direct interaction between
nurses and clients will reduce the quality of health care. This concern arises because
they think that direct contact with patients is very important, especially for emotional
support and therapeutic touch. Other disadvantages of telenursing include the
possibility of technological failure, increased risk to security and confidentiality of
client documents.

F. Research on Telenursing
1. In 2004-2005 the International Telenursing Role conducted a survey aimed at
identifying satisfaction with telenursing, telenursing knowledge and skills,
perceptions of telenursing effectiveness, need for telenursing, skills and
knowledge required in telenursing. This study surveyed 719 telenurses (628
women and 89 men) from 36 countries. 66% of the respondents were from the
U.S. with the majority coming from Canada. Of all the respondents 50% of the
nurses worked part time in telehealth and some in hospitals. The nurse was very
happy to receive telehealth training. These nurses were very satisfied with
telenursing based on autonomy, interaction, professional status, pay, tasks,
workplace comfort. Most of the telenurses surveyed, 75 per cent, were very
satisfied with telenursing based on autonomy, interaction, professional status,
pay, tasks, workplace comfort.

among them believe that educational certificates are important in telenursing.

According to respondents, the important components of the education
programme are
techniques using equipment, knowledge based on standard protocols and clinical
care competencies. 89% of respondents believe that telenursing is part of basic
nursing education. Telehealth education should consist of clinical experience.
Here are the results of the International Telenursing Role survey on the types of
patient care that require telenursing.
2. A study conducted by Helen A. Snooks et al entitled "Real Nursing?
Telenursing Development" in a National Health Service in the UK in 2007. Data
collection in this study used a structured questionnaire method to 111 nurses who
worked there. The purpose of this study was to find out the nurses' perspective on
the impact of telenursing. From this study, it was reported that the reason they
joined the telenursing service was because of the increase in salary and flexible
working. Two-thirds of them reported increased job satisfaction and development
of nursing skills. There was another study entitled: "Telenurses' experiences of
working with computerised decision support: supporting, inhibiting and quality
improving" which was conducted by

Annica Ernesa et al, in 2006 were students at the Department of Public Health
and Caring Sciences, Uppsala University, Sweden and the Department of Public
Health and Caring Sciences, Uppsala University, Sweden.
Department of Caring Science and Sociology, University of Ga¨ vle, Sweden.
This study aims to describe the experiences of telenurses working with
computerised support systems and how these systems may affect their work. This
is a qualitative study with eight Registered Nurse (RN) participants using semi-
structured interviews. The RNs were from three telephone counselling centres in
Sweden that use computers to support their services. The results showed that the
telenurses found the decision support system simplified their work,
complemented their knowledge, gave them security and increased their
credibility. They also described how the systems sometimes contradicted their
own opinions. Participants said that computerised systems cannot replace nurses'
knowledge and competence.
4. In addition to the experiences conveyed by nurses, families and patients also
convey their experiences of telenursing, such as in a study entitled: "Patient And
Carer Perspectives Patients and families experiences with video telehealth in
rural / remote communities in Northern Canada" conducted by Pat Sevean, et al.
Where the purpose of this study was to determine the experiences of patients and
families about consultations with video telehealth as a method of providing
health services in remote villages in Northern Canada. This study uses a
qualitative approach with data collection methods using video and semi-
structured interviews with participants 10 patients and 9 family representatives
who have used telenursing facilities for at least 1 year. Results

The study showed that participants raised the advantages of telehealth

These include reducing burden (travel costs, accommodation, lost wages, lost
time and physical limitations), maximising support (access to family, friends,
familiar home environment, carers and other service providers).

G. Factors inhibiting the application of telenursing and how to overcome them

The issue that occurs in the provision of health services in the form of
telenursing is that the practice of telenursing is still prohibited, for example in one of
the superpowers, the United States, the practice of telenursing is prohibited because
nurses who are online as coordinators must have a permit or licence in each state and
patients who receive telecare must be local to avoid interstate nurse malpractice.

Malpractice and accountability related to telenursing are still being debated

and solutions are being sought.
 There are several issues that need to be considered in the implementation of
telehealth
That is:
1. Financing.
Financing is a barrier to telehealth delivery. Although it is found that
telehealth has many benefits. The government is still lacking in developing telehealth.
2. Legal aspects
The legal aspect states that: citizens must be protected from the bad practices
of health workers
3. Safety standards
Attention in app technology in services health services
is

patient safety. The telehealth service system must be able to ensure safety for
patients. In this regard the ANA (American Nursing
Association) published 3 telehealth guidelines viz: Basic principles of telehealth in
1998, telehealth competencies in 1999 and developing telehealth protocols in 2001.
4. Data security
Telehealth requires electronic health records, which are prone to data
privacy, confidentiality and security, so the implementation of telehealth must be
able to guarantee data security.
5. Communication infrastructure
Telecommunications infrastructure is the part of telehealth that has the largest
percentage of costs. Another issue, is that tools for interfaces will be difficult to
organise telehealth if there is no interconnection between tools.
The use of telenursing in countries that are just starting to utilise it certainly
experiences obstacles, including:
1. Requires nurse resources that have more abilities, namely being able to

understand and utilise technology that is generally not available.

 It is easy to procure, requires the education of an information specialist, which
according to the author may not be in demand at this time.
2. Information technology and computer utilisation for all parties related to nursing
services will require a lot of money. As for the procurement of these
technological facilities, which are felt to require quite a lot of money, which is
difficult to realise by a society in a developing country such as Indonesia.

How to overcome barriers to telenursing application

In providing nursing care remotely, a general (integrated) health policy is
needed that regulates practice, SOPs/standard operations

procedures, ethics and professionalism, safety, patient confidentiality and assurance

of information provided. Telenursing activities must be integrated with strategy and
nursing practice development policies, the provision of nursing care services, and
nursing education and training systems that use health information models/internet-
based.
The implementation of telenursing in Indonesia is still not running well due
to limited human resources, limited facilities and infrastructure and lack of support
for the implementation of telenursing from the government. To overcome the
limitations of telenursing implementation, it can be started with simple equipment
such as telephone planes that are already widely owned by the community but are
still not widely utilised for the benefit of health services or nursing services.
Telenursing using telephones can be applied in the emergency department and home
care.
Nurses have an overall commitment to the need to maintain patient privacy
and confidentiality in accordance with the nursing code of ethics. Some of the things
related to this issue, which must be fundamentally done in the application of
technology in the health sector in caring for patients are:
1. The confidentiality and service guarantees of the health information provided
must be maintained.
2. Patients receiving interventions via telehealth should be informed of potential
risks (such as limited assurance of confidentiality of information, via the internet
or telephone) and benefits.
3. Dissemination of patient data such as patient identification (voice, image) can be
controlled by creating an informed consent via email.
4. Individuals who abuse confidentiality, security and regulations and misuse
information may be subject to penalties/legal aspects.
In the United States in particular, there are 29 states that have enacted laws on
telehealth provisions, ethics and regulations including telenursing which include

in the 1997 telehealth legislation based on The Telecommunications Reform Act of

1996 charged, and there are 53 bills being discussed in the US in the year under
review.
The.
Telenursing, where nurses use knowledge, skills, judgement and critical
thinking, is an integral part of nursing education. These activities can already be
given a licence to perform nursing care.
Legal definitions of care science almost always include :
1. Use of educational care science,
2. Critical thinking, and
3. Decision making.
So it is clear that telenursing is a legal job opportunity for the nursing
profession. Of course, the support of professional organisations in licensing is
needed.
 CHAPTE
R III
CLOSURE

A. Conclusion
Telenursing is an integral part of telehealth. Telenursing can be used to
provide professional nursing services with various methods (home care, on-call
nurses, providing information etc.). Telenursing can increase patients' independence
and satisfaction in fulfilling their health status. Telenursing can increase the active
participation of family in care. Telenursing is effective in patient care settings

who have chronic illnesses and diseases that cause dependence. Telenursing can also
be conducted in rural areas with adequate facilities and infrastructure.
technology and information.
Telenursing has several advantages according to Britton, Keehner, Still &
Walden in 1999, namely: Effective and efficient in terms of health costs, can
increase the scope and range of nursing services without geographical boundaries,
can reduce the number of visits and hospital stays, can improve services for chronic
patients, and can be utilised in the field of nursing education (distance learning
model) and the development of health informatics-based nursing research.
If we look at the development of telenursing in Indonesia, it is still very far
behind compared to other countries. In Indonesia, there are still very few health
institutions that use telenursing. Among these hospitals are Banyumas Hospital,
Fatmawati Hospital and several other hospitals in Jakarta that have developed
computer-based nursing documentation systems. However, we cannot turn a blind
eye to the obstacles faced by nursing in Indonesia. Among these obstacles are the
limited human resources that

mastering the field of nursing and information technology in an integrated manner,

still
The lack of infrastructure to implement information systems in the service world,
and the low interest of nurses in the field of nursing information technology.
Moreover, there is no institutional policy for the development of computer-based
information systems.
Developing a nursing information system requires a lot of preparation. In
addition to the infrastructure, the human resources of nurses must also be prepared.
The competencies, qualifications and skills that nurses should have in telenursing
practice are clinical competence, assessment skills in nursing practice areas. In
addition, nurses must also have personal characteristics that will facilitate their
involvement in telenursing, for example: positive attitude, open-mindedness towards
technology, knowledge and ability to use telenursing.

navigate technology systems and environments e.g. knowledge and skills to operate
technology, have an understanding of the limitations of technology
used, e.g. can determine if vital signs are being accurately monitored with specific
equipment, has knowledge and application of telehealth operational protocols, has
good communication skills.
 LITERATURE

Mardianto, Telenursing. http://www.fik.ui.ac.id/.../FUNGSI%20

Mey.
TELENURSING%20FOR%20KADER%20POSBINDU.rtf. Accessed on
Retriev
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18 November 2010.

Anonymous. IT Development in Nursing. http://www.google.com/xiumei87.

wordpress.com/2010/10/29/page/3/. Accessed on 18 November 2010.

Liza, Fera. Development Telenursing. http://www.fik.ui.ac.id/.../UTS%20SIM-

FERA%20LIZA%20NPM%200906594343.pdf. Accessed on 18 November

2010.

Rochmawati, DH. Telenursing. http://www.fik.ui.ac.id/pkko/files/tugas% 20sim

%20 heppy.pdf. Accessed on 18 November 2010.