Healthcare Anywhere: The Pledge of Telehealth

Laura A. Stokowski RN, MS


October 30, 2008

In This Article


Telenursing is a subset of telehealth that focuses on the delivery, management, and coordination of care and services using telecommunications technology within the domain of nursing.[7] Telehealth nurses use the nursing process to provide care for individual patients or defined patient populations over a telecommunication device.[7] Importantly, the nursing process and scope of practice are the same in telenursing as in traditional nursing practice.[7]

Among the many diverse clinical functions of telehealth nurses are monitoring patients with chronic diseases, helping patients manage their symptoms and co-morbidities, and coordinating care for patients who require services from numerous health professionals.[8]

"Telenursing is going through a lot of change right now," says Loretta Schlachta-Fairchild, RN, PhD, FACHE, president and CEO of iTelehealth Inc. "What started with the telephone has evolved into biosensors and wearable computers - a whole compendium of devices that transmit physiologic data to nurses." A huge side benefit of telenursing noted by Schlachter-Fairchild is that when patients start seeing all of their own data, they start connecting the dots about their disease processes, begin managing their diseases better, and dramatically reduce their utilization of acute care services, such as emergency department visits and hospitalizations.

Many healthcare providers, especially those in home care, are looking to telenursing applications as a way of providing care to more patients without needing more nurses. Saving time is achievable because driving time to reach patient residences is significantly reduced. Nurses are able to spend more time on direct patient care.[8]

"When making decisions about a telenursing system," explains Bonnie Wakefield, RN PhD, of the Harry S. Truman Memorial Veteran's Hospital in Columbia, Missouri, "you need to think about who you will use it for, and match technology to patient need." Do you really need a video component, for face-to-face interaction? Visual contact might be more important for hospice or psychiatric patients, but not as critical for chronic disease patients. Wakefield and colleagues compared nurse and patient communication between 2 telehealth modes: a standard telephone and a videophone, in patients who were being observed for chronic heart failure. They found that nurse perception of the communication did not differ between the 2 modes, nor did patient satisfaction.[9] "In this situation, the added expense and complexity of using a videophone was not worth it," says Wakefield.

Telephone call center nursing is a long-established form of telehealth nursing. Call centers can have many different labels, such as "Nurse Advice Line," "Ask-a-Nurse," or simply, triage. Some call centers are extensive, multi-state systems; others provide off-hours coverage for clinics or physician offices. Suzanne Wells, manager of a large pediatric call center in St. Louis, Missouri, explains "Telehealth nursing used to be called telephone triage, a label that didn't accurately describe what telehealth nurses do. Triage is only a part of telehealth nursing."

Telehealth nurses are a unique group of nurses who respond to patient healthcare needs over the telephone. And what could be easier than talking to patients on the phone all day? No 12-hour shifts on your feet, no lifting heavy patients, no answering call lights. While telehealth nursing does have its perks, it's not as simple as it sounds. Imagine if you had to assess your patients with your eyes closed and without using your hands and you will get an idea of the difficulty that telehealth nurses must overcome with every patient encounter. Telehealth nurses must maintain the same quality of care, but without the advantage of visual and other sensory assessments. Telehealth nurses are usually limited to the information they receive from patient report, tone of voice, and responses to questions. From this, they must develop and communicate a plan of care, all in about 10 minutes.

Telehealth nurses provide nursing care by: (1) using clinical algorithms, protocols, or guidelines to systematically assess patient needs and symptoms; (2) prioritizing the urgency of patient needs; (3) collaborating and developing a plan of care with the patient and supportive disciplines, which may include recommendations for care, call back instructions, and education; and (4) evaluating outcomes.

One of the biggest challenges faced by Suzanne Wells' staff of nurses is that today's callers are different than those in years past. Today's callers, having grown up with technology, have higher expectations. They are accustomed to quick responses and immediate solutions.

The call center is not the place for novice or inexperienced nurses. Nurses who respond to caller concerns about themselves, their children, or others under their care, must have strong clinical and critical thinking skills to overcome the disadvantages of practicing without face-to-face interaction.


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