Assessing the Impact of Telemedicine on Nursing Care in Intensive Care Units

Ruth Kleinpell, RN, PhD, APRN-BC, CCRN; Connie Barden, RN, MSN, CCRN-E, CCNS; Teresa Rincon, RN, BSN, CCRN-E; Mary McCarthy, RN, BSN; Rebecca J. Zapatochny Rufo, RN, DNSc, CCRN

Disclosures

Am J Crit Care. 2016;25(1):E14-E20. 

In This Article

Abstract and Introduction

Abstract

Background Information on the impact of tele–intensive care on nursing and priority areas of nursing care is limited.

Objectives To conduct a national benchmarking survey of nurses working in intensive care telemedicine facilities in the United States.

Methods In a 2-phased study, an online survey was used to assess nurses' perceptions of intensive care telemedicine, and a modified 2-round Delphi study was used to identify priority areas of nursing.

Results In phase 1, most of the 1213 respondents agreed to strongly agreed that using tele–intensive care enables them to accomplish tasks more quickly (63%), improves collaboration (65.9%), improves job performance (63.6%) and communication (60.4%), is useful in nursing assessments (60%), and improves care by providing more time for patient care (45.6%). Benefits of tele–intensive care included ability to detect trends in vital signs, detect unstable physiological status, provide medical management, and enhance patient safety. Barriers included technical problems (audio and video), interruptions in care, perceptions of telemedicine as an interference, and attitudes of staff. In phase 2, 60 nurses ranked 15 priority areas of care, including critical thinking skills, intensive care experience, skillful communication, mutual respect, and management of emergency patient care.

Conclusions The findings can be used to further inform the development of competencies for tele–intensive care nursing, match the tele–intensive care nursing practice guidelines of the American Association of Critical-Care Nurses, and highlight concepts related to the association's standards for establishing and sustaining healthy work environments.

Introduction

Telemedicine in the intensive care unit (tele-ICU), or the use of telehealth techniques to provide care for acute and critically ill patients, has changed the way care is provided in ICU settings. Intensive care unit telemedicine has been defined as a technological innovation that uses audio, visual, or combined audiovisual communication to provide critical care from a remote location.[1] The use of ICU telemedicine enables clinicians to remotely monitor patients' vital signs, physiological status, and results of laboratory and diagnostic tests and to provide interventions as indicated by a patient's condition. Telemedicine also enables clinicians working in ICU settings to obtain consultation from expert practitioners at the remote monitoring site to promote best care for patients.[2–5]

The United States has approximately 45 tele-ICUs that reach more than 200 hospitals, with monitoring capability for more than 6000 beds (12% of ICU patients in the United States).[6] Although according to estimates, 800 to 1000 nurses currently practice in tele-ICUs and more than 16 000 bedside nurses interface with these units, information on the impact of tele-ICUs on nursing care is limited.

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