Nursing Infomatics-Tele-Nursing

Tele-nursing is the use of telecommunications technology such as videos, computers and tele-monitoring technologies to provide nursing care and advice at a distance. This growing technology offers many advantages in the delivery of healthcare information, disease monitoring, health promotion and disease prevention services, as well as nursing diagnosis, treatment and education to patient at home from a centralized location.

Tele-nursing can be instrumental in helping patients and families to be active participants in their care, particularly in the self-management of chronic illness such as congestive heart failure. It is a service that is currently offered by a growing number of hospitals and health maintenance organizations (HMOs), medical practice groups, and even primary physicians. One of the interesting components of tele-nursing is the modes of delivery of care. New technologies such as service-delivery programs and monitoring systems can configure to connect the patient to a nursing call center or to a specific practitioner.

One example is the Carematix Wellness System (CWS) which is based on advanced, patent-pending, wireless and internet technologies that are integrated into everyday health monitoring devices such as a blood-pressure monitor, weight scale, and glucose monitors. Furthermore, enables nurses to provide accurate and timely information and support online. Another advantage of tele-nursing is the continuity of care which can be enhanced by encouraging frequent contacts between health care providers and individual patients and their families.

Furthermore, tele-nursing is cost effective in reducing the requirement for or the length of hospital stays. It also facilitates increased access of services to widely dispersed and remote populations. Telenursing is a growing trend and is expansion in the field of nursing informatics. Bibliography Resources Resource 1 Suttenfield, K, Tokarski, C. & Kilbride,J. ( 2002). Highlights From the ATSP Telehealth Conference 2002: Briefings on Telemedicine Activity in the US and Abroad During the Past 12 Months. Retrieved August 3, 2008 from Medscape technical Medicine eJournal.

The researchers met to identify innovative way to advance telehealth. There researchers were well respected in the field of telemedicine from the Association of Telehealth . This conference identified various telecommunication methods that can transcend distance barriers while providing an effective and cost-efficient alternative to face-to-face encounters. The information was intended for health care provider for use on patients at home. The latest funding, reimbursement activities, legislative and regulatory issues, home telehealth and tele-nursing were some of the new advancements that needed refining.

As cost and time considerations force consumers, providers, and insurers to examine alternative ways of providing healthcare services, telehealth transactions was found to gain acceptance into the mainstream of traditional medicine. New and emerging technologies were identified such as home telehealth- using telemedicine to care for elderly patients at home, disease management- patients’ answers are stored in detailed Web-based records that analyze the data and identify clinical indicators over time and telepharmacy. Other methods were electronic health record and voice diagnostic and tele-nursing.

A growing need to promote the methodology of telehealth as a financially viable and widely acknowledged method of healthcare delivery was the underscoring principle mentioned. Resource 2 Renee Slater, M. , Phillips, D. , ; Woodard, E (2008) Cost-Effective Care a Phone Call Away: A Nurse-managed Telephonic Program for Patients with Chronic Heart Failure. Nursing Economics, Gale Group, Farmington Hills, Michigan. Retrieved August 3, 2008, from http://www. accessmylibrary. com/coms2/summary_0286-34213677_ITM The authors consisting of three nurses investigated the management of chronic heart failure (CHF) case through a telephonic program.

It was identified that the challenge of providing care for CHF case was not cost effective and methods to reduce the cost of care was investigated. There was 50% readmission rate within 6months of being discharged. The main reason for readmission was failure of the patient to identify warning signs of heart failure exacerbation such as shortness of breath and weight gain. The researchers used a 24hrs health information line called Vitaline to the patients to reinforce education received in the hospital on discharge.

Through Vitaline 854 CHF admission between 2002 to 2005 dropped to 200 at the completion of the program. The cost of care was also analyzed and it resulted in a 57% reduction in cost due to a decrease in the length of stay. In closing the program has shown excellent outcomes using the limited, though expert, resources. The research is relevant to tele-nursing as it shows that patients care can continue outside the walls of a hospital or nursing home and that there can be a reduction in the readmission of chronically ill patient.

Resource 3 Hutcherson, C. (2001). “Legal Considerations for Nurses Practicing in a Telehealth Setting”. Online Journal of Issues in Nursing. 6,(3), 3. Retrieved August 3, 2008 from www: nursingworld. org/ojin The author Carolyn Hutcherson , RN, MS, specializes in health care regulatory issues with special emphasis on licensure and credentialing, telehealth and e-health. She examines the complexity of the legal and regulatory bodies to understand and develop standards that is safe and effective to the practice of telehealth.

She raises many important issues to the practice such as whether there is a need for certification or additional credentialing for telehealth practice, the place of care since the providers are in different geographical location,, the crossing of state line and the laws that govern, whether it is the law that covers provider or the law of the stat that the patient is in. furthermore other issues involved are whether telephone and electronic nursing are within the scope of nursing practice as authorized by the state nurse practice acts.

Although many legal issues were questioned and identified, the author still sees tremendous possibilities for patients on remote locations. Resource 4 Allen,A. , Doolittle,G. , Boysen, C. , et al( 1999) An analysis of the suitability of home health visits for telemedicine, Journal of Telemedicine and Telecare 5:90-96. Retrieved August 3, 2008 from www: medscape. com The researchers examine the percentage of traditional home health nursing visits that could be done by telemedicine. Here a retrospective review of nursing charts clinical records were use. Two types of data were recorded.

The objective data, which were extracted from the records, included demographic information, patient assessments, teaching activities and interventions. Furthermore the subjective data were the opinions of four observers as to whether the visit could have been done using currently available telemedicine technology. There were 906 home nursing visits and a 54-item coding instrument was applied to it. It Ws found that for 412 visits, 46 could have been replaced with tele-nursing. These included the common primary diagnosis of airway obstructions to least life threatening as anemia.

The research concluded that tele-nursing can be used to substitute some of the home nursing visits thus reducing the cost of providing home care services. Resource 5 Ades, P. , Pashkow,F. , Fletcher, G. , Pina, I et al(2000). Controlled Trial of Cardiac Rehabilitation in the Home Setting Using Electrocardiographic and Voice Transtelephonic Monitoring. American Heart Journal 139(3):543-548, Mosby-Year Book, Inc. Retrieved August 3, 2008 from www: medscape. com The authors of this article are researchers from the Division of Cardiology, University of Vermont College of Medicine, Burlington, Vermont.

The study design was a multicenter, controlled trial done over a period of three months. The outcome variables were peak aerobic capacity and quality of life, as measured by the Health Status Questionnaire cardiac rehabilitation. The goal of this study was to compare the effectiveness of home-based, transtelephonically monitored cardiac rehabilitation with standard, on-site, supervised cardiac rehabilitation. The sample group included 83 people who were home-based transtelephonically monitored from home and 50 patients who were monitored from a standard on site rehabilitation program.

The results showed that patients in the home-based monitoring program increased peak aerobic capacity to a similar degree as patients who exercised on site (18% vs 23%). Quality of life such as physical and social functioning, physical role and emotional role limitations, bodily pain, and energy/fatigue improved similarly in both groups. The conclusion was that patients with coronary heart disease can effectively participate in home-based, monitored cardiac rehabilitation, with exercise and quality of life improvements comparable to those demonstrated at on-site programs Resource 6

Russo, H( 2001). “Window of Opportunity for Home Care Nurses: Telehealth Technologies”. Online Journal of Issues in Nursing. 6 (3), 4. Retrieved August 3, 2008 from : www. nursingworld. org/ojin Holly Russo is a registered nurse with a Masters of Science degree in clinical evaluative studies from Dartmouth College. Russo provided examples of telehealth nursing in home care, and discuss the future of telehealth technologies in nursing. One of the example is Kaiser Permanente who has also pioneered telehealth nursing in home care.

In a study by Barbara Johnson (2000), 100 patients received cardiopulmonary, cancer, wound, and/or diabetic home health care in the traditional face to face fashion, and 100 patients received some of their visits via a video system staffed 24 hours a day by trained home care nurses. In this study, Kaiser utilized a device called the Personal Telemedicine System, produced by American Telecare, Inc. , which allows home health nurses to see the patient in real time, listen to heart and chest sounds, and check to see if that patient is taking his or her medications properly.

Johnston reported that cardiopulmonary disease patients received the greatest benefit from the system caregivers. Resource 7 Buckley K. ,Tran,B (2001) Receptiveness, Use and Acceptance of Telehealth by Caregivers of Stroke Patients in the Home Online Journal of Issues in Nursing. 9 (3); Available: http://nursingworld. org/ojin The authors are professors in the School of Nursing at The Catholic University of America. They specialized in telehealth and advanced telecommunications systems for remote delivery of nursing support for caregivers of stroke survivors.

A qualitative exploratory descriptive study was conducted through randomized selection. The sample size was 75 caregivers. The purpose of the study was to determine factors that influenced caregivers’ receptiveness, use and acceptance of telehealth videophones by 21 families of stroke patients in the home setting. According the study, family receptiveness toward telehealth appears to be dependent upon caregivers’ concerns about privacy and home security, proper timing of services offered, perceived need by caregivers for support, and the level of caregiver burden.

However, the research also conclude training of nurses and caregivers to develop the skills appropriate to the technology and helping them to feel comfortable with telehealth is essential to its use and effectiveness. Search Strategies: The source of material was found using keywords as the subject and the content. The search for tele-nursing, telehealth, telemedicine, remote monitoring device and telehome care was used in the Google search engine. The relevancy of the information was screened as well as the reliability and credibility was examined.

Selected journal from scholarly sources were examined. The Medscape site was also used after subscribing to it. The search resulted in many articles, some of which were scholarly and relevant to the topics. Nursingworld was also a source of reference. Conclusion -Reaction to the citation- the information obtained was a collection of relevant research materials for scientific journals obtained from online sources. The sources were primary and accuracy and relevance to the topic was maintained to reduce biases.

The citations mentioned above, draw from the information available for tele-nursing and show its importance in the health care community. Furthermore tele-nursing is shown to be a growing field that will change the way health care is delivered to remote areas. The references identified strongly agree with the new technology as it will reach many of the underprivileged, the indigent and the elderly. It will also expand ways in which nurses care for patients and in the quest for disease prevention and follow up care. References

Ades, P. , Pashkow,F. , Fletcher, G. , Pina, I et al(2000). Controlled Trial of Cardiac Rehabilitation in the Home Setting Using Electrocardiographic and Voice Transtelephonic Monitoring. American Heart Journal 139(3):543-548, Mosby-Year Book, Inc. Retrieved August 3, 2008 from www: medscape. com Allen,A. , Doolittle,G. , Boysen, C. , et al( 1999) An analysis of the suitability of home health visits for telemedicine, Journal of Telemedicine and Telecare 5:90-96. Retrieved August 3, 2008 from www: medscape. com Buckley K.,Tran,B (2001)

Receptiveness, Use and Acceptance of Telehealth by Caregivers of Stroke Patients in the Home Online Journal of Issues in Nursing. 9 (3); Available: http://nursingworld. org/ojin Hutcherson, C. (2001). “Legal Considerations for Nurses Practicing in a Telehealth Setting”. Online Journal of Issues in Nursing. 6,(3), 3. Retrieved August 3, 2008 from www: nursingworld. org/ojin Renee Slater, M. , Phillips, D. , ; Woodard, E (2008) Cost-Effective Care a Phone Call Away: A Nurse-managed Telephonic Program for Patients with Chronic Heart Failure.

Nursing Economics, Gale Group, Farmington Hills, Michigan. Retrieved August 3, 2008, from http://www. accessmylibrary. com/coms2/summary_0286-34213677_ITM Russo, H( 2001). “Window of Opportunity for Home Care Nurses: Telehealth Technologies”. Online Journal of Issues in Nursing. 6 (3), 4. Retrieved August 3, 2008 from: www. nursingworld. org/ojin Suttenfield, K, Tokarski, C. ; Kilbride,J. ( 2002). Highlights From the ATSP Telehealth Conference 2002: Briefings on Telemedicine Activity in the US and Abroad During the Past 12 Months. Retrieved August 3, 2008 from Medscape technical Medicine eJournal.