Telehealth or Telemedicine in Nursing

Telehealth or telemedicine refers to the use of information and telecommunication technologies to deliver health care services at a distance. It gained widespread support over the two previous decades, primarily as a way of supporting patients in remote settings (Graves & Doucet, 2016). Although telehealth offers substantial advantages, such as heightened flexibility and convenience, it has also encountered resistance due to the training and resources necessary and the increased risk of errors. The COVID-19 pandemic bolstered telehealth adoption due to its compatibility with social distancing. I chose telehealth as my topic because I think that its full potential for improving patient access and outcomes has not yet been realized. Furthermore, I believe that its continued development will benefit from post-pandemic momentum, making it highly relevant. In my research, I used the CINAHL Complete, Health & Medical Collection, and Public Health Databases, searching them for peer-reviewed articles written since 2016. In addition to “telehealth” or “telemedicine”, the keywords used included “patient satisfaction”, “nursing”, “interdisciplinary”, “interprofessional”, and “implementation”. By focusing on those topics, I intended to investigate telehealth’s capabilities and limitations, its use in practice, and stakeholders’ perception of this technology.

Annotated Bibliography

Bagot, K., Moloczji, N., Arthurson, L., Hair, C., Hancock, S., Bladin, C., & Cadilhac, D. (2020). Nurses’ role in implementing and sustaining acute telemedicine: a mixed‐methods, pre‐post design using an extended technology acceptance model. Journal of Nursing Scholarship, 52(1), 34-46. Web. 

This study investigates the factors influencing the implementation of telehealth in acute stroke care. It employs surveys using the Technology Acceptance Model to examine clinician attitudes towards a new telehealth service. Separate pre-implementation and post-implementation surveys were conducted for nurses and other medical professionals. Participants were asked to rank specific considerations that may influence implementation and answer open-ended questions about the program’s strengths and improvement areas. The authors found that nurses regarded perceived usefulness as the most important consideration before deployment, while non-nurses emphasized ease of use and social influence. Afterward, both groups rated usefulness highly, but nurses were more likely to mention facilitating conditions and identify the importance of continuous training for sustaining the program. As seen in subsequent interviews, nurses viewed ease of use issues as significant obstacles to implementation. Both groups agreed that the program helped improve patient care through simplified clinical access and support. The article shows that nurses are actively involved in implementing and sustaining telehealth. It sheds light on problems that come up during the implementation of telehealth services, as well as on differences in attitudes that may affect interdisciplinary collaboration.

Ellimoottil, C., An, L., Moyer, M., Sossong, S., & Hollander, J. E. (2018). Challenges and opportunities faced by large health systems implementing telehealth. Health Affairs, 37(12), 1955-1959. Web. 

This article summarizes the lessons learned by four large health care systems following successful telehealth implementation. The authors examine the challenges telehealth implementation teams faced at Emory Healthcare, Jefferson Health, Massachusetts, General Hospital, and Michigan Medicine and the approaches chosen to overcome them. Those challenges include executive skepticism, prioritizing support for new telehealth programs, staff level resistance, onboarding patients, and evaluating outcomes. Health care executives were persuaded to support telehealth implementation through data showing improvements in patient satisfaction and cost reductions following pilot programs. Unique frameworks were developed to evaluate proposed telehealth programs and engage staff members by encouraging new proposals and rewarding active participation. The organizations used dedicated websites and staff coordinators to educate patients about this novel form of treatment. Program-specific criteria were adapted to evaluate patient outcome improvements. Those improvements include increased access to care, heightened productivity, and reduced costs, lengths-of-stay, and readmissions. The article emphasizes the importance of involving clinicians at different staff levels in telehealth implementation, including nurses who could play a crucial role in patient education. It is valuable because of its empirical examination of organizational factors that might impede or support large-scale implementation.

Gibson, J., Lightbody, E., McLoughlin, A., McAdam, J., Gibson, A., Day, E., Fitzgerald, J., May, C., Price, C., Emsley, H., & Ford, G. A. (2016). ‘It was like he was in the room with us’: Patients’ and carers’ perspectives of telemedicine in acute stroke. Health Expectations, 19(1), 98-111. Web. 

This study examines the perception of an acute stroke telehealth program by patients and carers. The authors interviewed individuals who were involved in live or mock-up telehealth consultations dealing with acute stroke. Participants were asked questions connected to normalization process theory domains: sense-making, participation, action, and monitoring. Their answers allowed the authors to gauge their understanding and opinions of the telehealth service. The overall response was highly positive, confirming that telehealth can be a sustainable and cost-effective method of providing timely assessment and assistance for a higher number of acute stroke patients. The participants also identified multiple issues, such as increased emotional alienation and the heightened importance of staff technical and communication skills. Some participants expressed a preference for face-to-face consultations but accepted remote meetings for emergencies. The study highlighted the importance of effective communications between members of different professions in cases such as nurses on the spot coordinating activities with remote physicians. This article is invaluable for its insights into patient satisfaction outcomes, which constitute one of the main criteria for evaluating telehealth implementations’ success due to its connection to patient-centered care.

Graves, M., & Doucet, S. (2016). Factors affecting interprofessional collaboration when communicating through the use of information and communication technologies: a literature review. Journal of Research in Interprofessional Practice and Education, 6(2). Web.

This article surveys the literature on facilitators and obstacles to interdisciplinary collaboration in telehealth. The authors carried out a narrative review encompassing 56 selected papers on the interactions between information and communication technologies and interdisciplinary collaboration in health care. Factors supporting interprofessional cooperation using telehealth included training and organization, technical support, communications, commitment to patient-centered care, telehealth acceptance, and administrative and leadership support. Conversely, technical and organizational issues and relationship problems such as mistrust and resistance to the technology posed the main obstacles. According to the authors, the correct implementation of telehealth may promote patient-centered care by facilitating patient participation in care team discussions, ensuring continuity of care, and maximizing community supports. Remote appointments could improve patient experiences by reducing the demand on their resources and fostering an atmosphere of trust. Telehealth can also enable more effective and persistent communications between members of interprofessional care teams if they can overcome the identified obstacles. This review’s significance lies in the potential of telehealth to boost interdisciplinary collaboration and the importance of such cooperation to many telehealth programs.

Conclusion

Although its implementation can be challenging, telehealth offers a promising way to improve outcomes for both patients and health care providers. Its key advantages are increased convenience, expanded and simplified access to care, and expedited emergency responses. While implementing telehealth programs can be costly in the short term, it may be cost-effective in the long run due to increased productivity. Obstacles to implementation within a health care system include reluctance at different levels to adopt new technologies and procedures, insufficient communication and technical skills, and organizational challenges. Introducing telehealth in an organization should be accompanied by an education campaign on its benefits and best practices. Staff engagement should be secured by soliciting input and proposals for telehealth implementations in relevant areas of practice. Evidence-based evaluation frameworks should allow organizations to direct administrative support and resources to the most promising telehealth programs. As well as increasing patient satisfaction due to higher convenience, telehealth can improve outcomes by facilitating interdisciplinary collaboration. Persistent remote communications between interprofessional care team members, including patients and carers, can help attain a higher level of adherence to patient-centered care.

References

Bagot, K., Moloczji, N., Arthurson, L., Hair, C., Hancock, S., Bladin, C., & Cadilhac, D. (2020). Nurses’ role in implementing and sustaining acute telemedicine: a mixed‐methods, pre‐post design using an extended technology acceptance model. Journal of Nursing Scholarship, 52(1), 34-46.

Ellimoottil, C., An, L., Moyer, M., Sossong, S., & Hollander, J. E. (2018). Challenges and opportunities faced by large health systems implementing telehealth. Health Affairs, 37(12), 1955-1959.

Gibson, J., Lightbody, E., McLoughlin, A., McAdam, J., Gibson, A., Day, E., Fitzgerald, J., May, C., Price, C., Emsley, H., & Ford, G. A. (2016). ‘It was like he was in the room with us’: Patients’ and carers’ perspectives of telemedicine in acute stroke. Health Expectations, 19(1), 98-111.

Graves, M., & Doucet, S. (2016). Factors affecting interprofessional collaboration when communicating through the use of information and communication technologies: a literature review. Journal of Research in Interprofessional Practice and Education, 6(2).