Telehealth in Nursing Practice

The last few decades have been marked by tremendous technological advancements providing for ever-increasing possibilities when it comes to transmitting, accessing and storing information. As many others professions, the nursing profession is embracing technology in an effort to make nursing care more efficient, cost effective and flexible. This paper will explore how telehealth is reaching a wide variety of clients as in hospice, virtual wards and remote cardiac monitoring, thereby offering a safe, affordable and convenient alternative to traditional care. Telehealth and hospice

Telehealth presents patients and their families with choices and flexibility when it comes to end-of-life care. Something as simple as having a nurse available 24 hours a day to answer questions over the phone can make it possible for a family member to care for their loved one at home and therefore allow the patient to decide where s/he will spend his/her last weeks, days and hours of their lives. Fraser Health Hospice Pallitative Care, Canadian program, is utilizing this alternative for their patients (Roberts, Taylor, MacCormack, & Barwich, 2007). By using elementary technology Fraser Health is, in collaboration with B. C. NurseLine, making nursing care more accessible to hospice patients.

This arrangement saves patients and their families not only the inconvenience but also the physical and emotional toll of otherwise needless and expensive visits to the emergency room. Recognizing the need for access to services after office hours, caregivers for home-based patients are provided with the telephone number to a tele-triage and health information call center, which is open 24 hours a day seven days a week. The caregiver can thus call anytime s/he has any concerns or questions about the care of the patient. The call center’s phone is answered a nurse who after making her assessment over the phone can refer the case to the appropriate specialty nurse on call (Roberts, Taylor, MacCormack, & Barwich, 2007). Virtual wards

A pilot program funded by Croydon Primary Trust is exploring the possibility of providing more affordable care utilizing technology. The program targets patients who are at high risk for hospitalization and offers them an alternative model of treatment (Lewis, 2007). Patients identified with an increased risk for hospitalization are, after being assessed in their home, admitted to a virtual ward. The virtual ward offers different levels of nursing care to which the patients are assigned in accordance with their condition. The staff for the virtual ward includes a pharmacist, doctor, social workers, nurses and other healthcare professionals.

A ward administration coordinates communication between the team members and the patients by means of email and telephone. When a patient’s condition improves and s/he is no longer at a high risk for hospitalization, s/he is discharged. The philosophy behind the program is that it is cheaper for heath organizations to concentrate their resources on patients at high risk for hospitalization. By investing in a coordinated preventive treatment plan; a virtual ward, utilizing the phone and email, expensive hospitalizations are reduced in number, which in turn reduces healthcare costs (Lewis, 2007). Remote Cardiac Monitoring

A tertiary care facility in Pennsylvania with a cardiac telemetry capacity problem have embraced a new approach for servicing stable, yet acutely ill patients who need cardiac monitoring, namely, a nurse-managed remote telemetry model (Reilly & Humbrecht 2007). Remote telemetry allows for personnel, whom are not directly involved in patient care, to monitor patient cardiac activity at a central location. In this model the patient is admitted by a physician and assigned to a monitor nurse. After reviewing the admission information the nurse assesses if the patient is a candidate for remote cardiac monitoring.

The monitoring facility is staffed with a monitor technician and supported by the monitor nurse. In addition, each telemetry unit makes the patients cardiac rhythm available for the monitor nurse and the physician to view. The monitor nurse, who stays in contact with the patient’s primary nurse, also evaluates each patient on a daily basis and assesses the continued need for telemetry. In the event that a patient develops a cardiac arrhythmia, the monitor technician contacts the patient’s unit using both a cell phone and dedicated landline. Though remote telemetry has been found to deliver safe and effective monitoring, some discussion still remains. One concern is that lack of adherence to and improper criteria for admission to telemetry may lead to inappropriate telemetry monitoring (Reilly & Humbrecht, 2007). Conclusion

Telehealth nursing can, as with the Canadian pallitative care program, offer a convenient and affordable alternative for delivering nursing intervention and support for the hospice patient and their loved ones. In addition, telehealth can, as demonstrated by the Croydon program, deliver preventive treatment for patients with a high risk of hospitalization, while models, like the nurse-managed remote telemetry model in Pennsylvania, can resolve facility capacity problems. Thus, telehealth nursing may promise a safe, convient and costeffective alternative to conventional care for paitients, health organizations and proffesionals.

References
Lewis, G. (2007). Virtual wards, real nursing. Nursing Standard, 21(43), 64. Reilly, T., & Humbrecht, D. (2007). A nurse-managed remote telemetry model. Critical Care Nurse, 27(3), 22-33.
Roberts, D., Taylor, C., MacCormack, D., & Barwich, D. (2007). Telenursing in hospice palliative care. Canadian Nurse, 103(5), 24-27.