Lesson 11 - TeleNursing

Company

LOGOSheila Lyn U. Recidoro May 2011

Telenursing and Remote Access Telehealth

Sheila Lyn U. Recidoro May 2011

Objectives

Explore the use of telehealth technology in nursing practice.

Identify socioeconomic factors likely to increase the use of telehealth interventions.

Describe clinical and nonclinical uses of telehealth.


Objectives

Specify and describe the most common telehealth tools used in nursing practice.

Explore telehealth pathways and protocols.

Identify legal, ethical and regulatory issues of home telehealth practice.


Objectives

Describe the role of the telenurse. Apply the Foundation of Knowledge model

to home telehealth.


Telehealth

referring to and a wide range of health services that are delivered by telecommunications-ready tools

telephoneVideophoneComputer

GOAL : to improve care delivery services in any location


Evolution :

Early 1970’s:

Telemedicine teleradiology telepathology

(Allan, 2006).


Evolution

After several decades :clearer imagingmore speedy transmissionsaccurate replication of data from remote

locations to a central hub. The end results : helped to ensure that

professionals can replicate usual clinical interactions in all specialties regardless

of the distance involved in the contact.


Nursing Aspects of Telehealth

Understanding telehealth and the potential use of telehealth technology in nursing practice is necessary in today’s changing healthcare arena.

Telehealth interventions or contacts are performed off-site and often require less time spent on task because of the efficiencies offered by the technology applications.


Driving Forces For Telehealth

Demographics nursing/health care worker shortages chronic conditions educated consumers excessive costs of health care services



By the year 2040, 21% of the U.S. population—one in five Americans—will be 65 years old or older and there will be almost four times as many very old people, over 85, as there are today

Institute of Aging (1996).



Nursing shortage is two-fold: there is a greater need for nurses by more

persons, particularly those living lifetimes with sometimes multiple co-morbidities

significant decrease in the number of young persons entering the nursing profession.



A recent report from the Health Resources and Services Administration (HRSA) (2002) on the shortage of RNs :

2010 : rise from 6% - 12% 2015 : more than triple in size to 20%

.



Telehealth use may enhance nurses job satisfaction and help to retain nurses in their current positions

study by the Pennsylvania Homecare Association and Penn State University

(2004)



More than 100 million Americans are living with one or more chronic diseases or conditions.

U.S. : Medical care costs of people with chronic diseases account for more than 75% of the $1.4 trillion medical care expenditures.

Centers for Disease Control and Prevention (2005

National Concern : Securing appropriate, adequate, and affordable care services



The wave of today’s aging Baby Boomers is driving some of the usual health service practices toward a very different course.

Many of these individuals are more educated than their parents and more comfortable with use of technology.

New plans for this new generation of consumers are very much leaning toward meeting their demands for when-needed, as-needed care—or, care services delivered on their own terms and timing.



American health care system spends $1.4 trillion/year on conventional medical care.

Much more should be expected to be spent annually in the coming decades.

A solution is to develop a new clinical model for American healthcare that includes technology.

Telehealth technology should be included to fill the gap resulting from an overabundance of patients and a scarcity of health care providers.


Telehealthcare

generally used as an umbrella term to describe all of the possible variations of healthcare services which use telecommunications.

Store-and-forward telehealth: digital images, video, audio and clinical data are captured and “stored” on the client computer

or device; then, at a convenient time, the data are transmitted

securely (“forwarded”) to a specialist/clinician at another location where they are studied by the relevant specialist/clinician.


Telehealthcare

In real-time telehealth, a telecommunications link between the involved parties allows a real-time or “live” interaction to take place.

Use of computers for real time two-way audio and video streaming between centers over ever improving and cheaper communication channels is becoming common.


Telehealthcare

Examples of real-time clinical telehealth applications include: Telemental health Telerehabilitation Telehomecare Teleconsultations Telehospice/ telepalliative care


Telehealthcare

In remote monitoring, devices are used to capture and transmit biometric data.

Telephone monitoring is the most basic type


Telenursing

Telenursing refers to the use of telecommunications and information technology for providing nursing services

Health care to enhance care whenever a physical distance exists between patient and nurse, or between any number of nurses

(Skiba, 1998).


Telenursing

Home Telehealthcare - the most developing area of telenursing

today More than 90% of seniors want to remain

independent at home and age in place. Association for Retired Persons (AARP)(AARP, 1996)

Care at home is clearly a key concern and preference.


Home care Telenursing

customized patient education in dietary or exercise needs

nursing teleconsultations review of results of medical tests and exams assistance to physicians in the

implementation of medical treatment protocols.


Home care Telenursing

Telenurses can well expect to play a vital and dynamic role in the changing delivery systems that are to be in place in the next decades.


Terms of Home Telehealth

There is a wide and growing range of telecommunications-ready tools readily available for nurses’ and patients’ use in the home.

Central stations, web servers and portals are various terms presently used for multifunctional telehealthcare platforms and application servers.



Central stations/web servers are key components to telehealth that can be as minimal as a single screen display or may be more comprehensive software applications that provide various functions including triaging the data according to medical alerts which allow clinicians to quickly identify patients requiring immediate attention.



Peripheral biometric devices can consist of fully integrated systems such as a vital signs monitor or they may be stand-alone telecommunications-ready devices such as blood pressure cuffs and blood glucose meters.

Telephones are already the most familiar household communications tool used in telehealthcare.

A telephone device can also be augmented for easier use by patients, as needed, with a lighted dial pad, an auto-dial system, and/or louder ringer.



Video cameras and videophones are easily available consumer items that can be used in telehealth for show-and-tell demonstrations by nurses for patients, or to capture wound healing progress, among other applications.

Personal Emergency Response Systems (PERS) are well-known signaling devices worn as a pendant or otherwise made easily accessible to patients to ensure their safety and to access emergency care when needed, must usually in case of a fall.



Sensor and activity monitoring systems can track activities of daily living of seniors and other at-risk individuals in their place of residence.

Medication management devices are addressing a well-recognized major problem in healthcare today: medication management and compliance.

32 million people are taking 3 or more medications daily, with even more medications typically being taken by those 65 years of age or older.


Home Telehealth Practice and Protocols

Home telehealth programs will differ depending on the type of technology used and the focus of the telehealth programs.

Informed written consent must be obtained from the client or designee before beginning the use of telehealth consultations.

Telehealth pathways and protocols ensure more focused work with patients and allow for targeted interventions.



The use of telehealth tools, together with clinical oversight/practice, allows for more efficient and effective clinical management by allowing the patients’ needs to drive the care.

As home telehealth protocols are utilized more extensively, the improved clinical and operational efficiencies may ultimately impact the home care agencies’ bottom lines.



Telehealth is affected by certain legal, ethical and regulatory issues of which nurses should be aware.

Pointed efforts must be continually undertaken by the nurses’ agencies to upgrade information systems to insure that a high level of security of data is provided at all times.


The Patient’s Role in Telehealth

The importance of ensuring patient satisfaction with home health service delivery has been predicted to be a “mega trend” in 2007 .

(Remington, 2007) By patients’ achieving a good understanding of

and performing self care by the end of their home health admission periods, an important goal of home telehealth has been attained.


The Foundation of Knowledge Model and Home Telehealth

Knowledge acquisition involves the nurse’s receiving the information from the telehealth devices via a variety communication modes.

Knowledge processing is understanding a set of information and ways it can be useful to a specific task.



After processing all of the current information, the nurse is able to target the appropriate next steps involving knowledge generation and knowledge disseminaton.

The nurse considers all of the data as it applies to this patient, and decides which is the best course of action to be taken and acts on the data.



The nurse determines how the knowledge will be used and disseminated.

Telehealth is a rapidly developing mode of health service delivery in which nurses can expect to play a key role.

The practice of telehealth will provide opportunities for telenurses to play a key role in care management across the healthcare continuum.


Thought Provoking Questions

1. Telehealth technology has extended the arms of traditional health care delivery into homes, clinics, and other environments outside the bricks and mortar of hospitals. Will the increased use of these telehealth technology tools be viewed as “de-humanizing” patient care or will they be viewed as a means to promote more contact with healthcare providers and new ways for people to “stay connected” as in on-line disease support groups), thereby creating better long term disease management and patient satisfaction?


Thought Provoking Questions

2. As telehealth technology advances towards seamless data access regardless of distance or health system, how can we protect patient privacy rights and the confidentiality of personal medical data?

Documents

Lesson 11 - TeleNursing