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

Results

A total of 1213 nurses responded to phase 1: nurses who worked in a tele-ICU (13.5%), bedside nurses who interfaced with the tele-ICU (76%), and nurses who worked in both capacities (10.5%). Number of years as a nurse ranged from less than 1 to 48 (mean, 16). A majority of the respondents (55.3%) had a baccalaureate degree in nursing, 27.0% had an associate degree, 8.5% had a master's degree, and 7.5% had a diploma. The number of years of critical care nursing ranged from less than 1 to 40 (mean, 12), and the number of years of tele-ICU nursing ranged from less than 1 to 20 (mean, 3). The demographic profile of the target group was reflective of the general population of nurses with respect to number of years as a nurse and number of years of critical care nursing. A higher percentage of the target group (55.3%) reported a baccalaureate degree in nursing; nationally, 37% of nurses report this degree preparation.[13]

Phase 1

Data from phase 1 were analyzed by using descriptive statistics. A majority of the respondents agreed to strongly agreed that tele-ICU systems offer nurses an opportunity to improve patient care (79.2%) and that tele-ICU is useful in their job (75.2%). Participants also agreed to strongly agreed that using the tele-ICU enables them to accomplish tasks more quickly (63%), improves collaboration (65.9%), improves job performance (63.6%), improves communication (60.4%), is useful in nursing assessments (60%), and improves care by giving more time for patient care (45.6%). Only 28.1% of the participants agreed or strongly agreed that tele-ICU can be a threat to patients' privacy (Table 1).

As shown in Table 2, a number of benefits to using tele-ICU were cited, including ability to monitor trends in vital signs, detect unstable physiological status, provide medical management, enhance patient safety, detect arrhythmias, prevent self-extubation, and prevent falls. As shown in the Figure, barriers to using the tele-ICU included technical problems (audio and video), interruptions in care, perception that tele-ICU is an interference, and attitudes of staff.

Figure.

Barriers to using the tele–intensive care unit (ICU).

Phase 2

In phase 2, a total of 60 respondents ranked priority areas of care (Table 3) identified in phase 1. Among the phase 2 participants, 93.3% were women; 68.3% had a baccalaureate degree in nursing, 15% had an associate degree, 10% had a master's degree, and 5% had a diploma in nursing.

Respondents were 22 to 66 (mean, 44.6) years old and had a mean of 9.5 (range, 2–40) years of nursing experience and a mean of 6 (range, 2–12) years working in their current setting. Respondents had a mean of 5 (range, 1.5–10) years of experience using tele-ICU and had worked a mean of 4 (range, 0–10) years as a tele-ICU nurse.

The responses from the modified Delphi rounds were compiled and rank ordered on the basis of respondents' ratings. The top 25 were rated in round 1 and the top 15 in round 2. Participants were asked to rank the top areas identified in phase 2 from most important (1) to least important (15). After round 1, the following priority areas were not retained in the top 15 because of lower rankings: clinical knowledge of the tele-ICU system, comfortable with technology, interpretation of electrocardiograms, conduct clinical consultations, accurate documentation of tele-ICU care, use of the tele-ICU system to optimize medical management, current ICU bedside experience, and self-confidence. Table 4 gives the rank for each of the 15 most important areas of care for tele-ICU nursing.

According to the highest response rates, the most important abilities overall (n = 60) in tele-ICU nursing included critical thinking skills, being an expert clinician with ICU experience, and skillful communication. The least important ability was ability to mentor. Respondents who worked as both an ICU bedside nurse and a tele-ICU nurse (n = 5) included critical thinking skills, expert clinical ICU experience, and monitoring for unstable physiological status as the most important abilities for a tele-ICU nurse. Use of tele-ICU to enhance patient safety, ability to interact with multiple disciplines, and ability to mentor were rated of lesser importance than were other priority areas.

Tele-health ICU nurses were more likely to report that being an expert clinician with ICU nursing experience and being comfortable with technology were more important considerations, whereas bedside nurses were more likely to identify clinical knowledge of the tele-ICU system and knowledge of ventilator management as more important. Both groups identified skillful communication, critical thinking skills, interpretation of electrocardiograms, understanding laboratory values, and knowledge of emergency patient management as important competencies.

Several respondents provided additional comments on their experiences with using tele-ICU. One wrote, "Tele-ICU experience is one of the most unique fields that I have worked so far, and it has a vast potential in terms of reaching out and enhancing patient safety and care." Another related, "It requires tremendous interpersonal relationships, however, professionally and effective communication with a variety of disciplines." Another remarked, "Tele-ICU competency is a great need. The multiple skills required are a mix of common and unique skills."

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