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Standards of Practice for Professional Telehealth Nursing

Standards of Practice for Professional Telehealth Nursing

Author: Capella Healthcare

Standards of Practice for Professional Telehealth Nursing

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what's covered
In this lesson, you will learn about different telehealth nursing standards. Specifically, this lesson will cover:
  1. AAACN Standards
  2. ANA Principles

1. AAACN Standards

The American Academy of Ambulatory Care Nursing (AAACN) established standards to which telehealth nurses are accountable. The standards are divided into the domains of Clinical Practice and Professional Performance. Each standard has a set of competencies required to meet the standard.

The competencies are not included in the table below but can be found in the AAACN Scope and Standards for Professional Telehealth Nursing - 6th Edition 2018 (available through purchase only).

Standards for Clinical Practice
No. Standard Description
1 Assessment The RN practicing telehealth nursing (TN) is solely responsible for the systematic collection and interpretation of data relating to the health needs and concerns of a patient, family, and/or caregiver.
2 Nursing Diagnosis Telehealth RNs (TRNs) analyze the assessment data to determine the nursing diagnostic statements for health promotion, health maintenance, or health-related problems or issues.
3 Outcomes Identification TRNs identify desired outcomes in an individualized plan of care to the patient, group or population.
4 Planning The RN practicing in a telehealth setting develops a plan that identifies strategies and alternatives to attain expected outcomes in individuals and/or populations.
5 Implementation The RN practicing in the telehealth setting identifies with the patient how to implement the plan of care.
5a Care Coordination/Transition Management TRNs in the care coordination and transition management (CCTM) role coordinate delivery of care within the practice setting and across healthcare settings.
5b Health Teaching and Health Promotion The RN practicing in a telehealth setting employs educational strategies that promote individual, community, and population health and safety.
5c Consultation TRNs provide consultation in developing interprofessional plans of care, enhancing the ability of other professionals, and effecting change.
6 Evaluation TRNs practicing in the telehealth setting evaluate progress toward attainment of stated outcomes.
Standards of Nursing Organizational and Professional Performance
7 Ethics TRNs practicing in the telehealth environment incorporate professional codes of ethics with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
8 Professional Development TRNs practicing in the telehealth setting continually attain and update knowledge and competency that reflect current telehealth nursing practice.
9 Research and Evidence-Based Practice (EBP) TRNs practicing in the telehealth setting actively participate in EBP initiatives and research activities to advance TN and improve patient outcomes.
10 Performance Improvement TRNs practicing in TN enhance the quality, efficiency, and effectiveness of clinical and professional nursing practice within their clinical settings and organizations.
11 Communication TRNs practicing in the telehealth setting communicate effectively using a variety of formats, tools, and technologies to build professional relationships and to deliver care across the continuum.
12 Leadership TRNs practicing in the telehealth setting demonstrate leadership behaviors in practice settings, across the profession, and in the community.
13 Collaboration TRNs practicing in the telehealth setting collaborate with patients, family members, caregivers, and other health professionals in the conduct of nursing practice.
14 Professional and Practice Evaluation TRNs practicing in the telehealth roles and/or settings evaluate their own and others’ nursing practice in relation to professional practice standards and guidelines, patient outcomes, organizational policies and procedures, and relevant governmental regulations and statutes.
15 Resource Utilization TRNs practicing in the telehealth setting utilize appropriate resources to plan, provide, and sustain EBP nursing services that are safe, effective, and fiscally responsible.
16 Environment TRNs practicing in the telehealth setting actively engage in initiatives that create and maintain an environment of care that is safe and hazard-free.
Based on the AAACN Scope and Standards for Professional Telehealth Nursing - 6th Edition 2018

big idea
As with all standards of care for nursing, the patient is at the center of care. When nurses engage in telehealth, the mechanism in which patients remain at the center of care may look different. Nursing uses a holistic care model, and even in telehealth, the holistic model is maintained through technological adaptations that consider what the patient sees, hears, and how their safety is maintained. These elements are not only fundamental to nursing, but also to the telehealth scope and standards of practice.

2. ANA Principles

In addition to the AAACN Scope and Standards of Practice for Professional Telehealth Nursing, the American Nurses Association (ANA) has 13 principles of connected health that the nurse must follow (ANA, 2019).

  • Principle 1: The use of connected health technologies does not alter the standards of professional practice when delivering healthcare, conducting research, or providing education. Developed by each profession, in this case nursing, these standards focus on the healthcare professional’s responsibility to provide lawful, evidenced-based and high-quality personalized care regardless of the method of delivery, grounded in the Nurses Code of Ethics.
  • Principle 2: As connected health is a method of healthcare delivery, the healthcare provided is subject to the same healthcare laws and board oversight as the healthcare provided in person. Healthcare professionals should understand, however, that due to the nature of connected health business models, certain interstate commerce, fraud and abuse, and other applicable state and federal laws not commonly encountered when delivering healthcare in person may apply
  • Principle 3: Healthcare services delivered via connected health technologies should prioritize improving access to quality healthcare that is guided by best available evidence, accepted clinical standards, and best practices. These services must include deployment of appropriate technological modalities which meet the patient’s needs, are practical and easy to use, and align with specific patient location and care setting.
  • Principle 4: Professional practice and healthcare delivery, regardless of venue and channel of delivery, mandates that healthcare professionals meet state-specific regulatory and institutional requirements in accordance with scope of practice. Due to variations in practice rules and regulations across states and facilities, providers must practice respective of these variations whilst delivering care via connected health.
  • Principle 5: Nursing and other healthcare professions are responsible for developing their own competencies to ensure the safe, effective and competent delivery of healthcare via connected health technologies using a patient- and family-centered team-based approach.
  • Principle 6: Healthcare services delivered via connected health technologies should be congruent with in-person care and must adhere to the best available evidence that represents current and emerging interdisciplinary standards of care, while recognizing the limitations inherent in technology to ensure optimal patient-centered outcomes.
  • Principle 7: When using connected health technologies, the integrity and therapeutic value of the patient-healthcare professional relationship should be established, maintained, and promoted via connected health.
  • Principle 8: Safeguards must be taken with the transmission of electronic information and communication conducted using connected health technologies in all connected health practice settings. This practice upholds the highest level of ethical conduct in the secure management of patient health information, patient privacy and confidentiality, and protection against unauthorized breach of information. This includes informing patients of the use of third-party technology providers, the risk of disruption in the integrity of those providers’ data management practices, and a commitment to protecting patients from such events.
  • Principle 9: Documentation requirements for healthcare services delivered via the utilization of connected health technologies should be consistent with requirements applicable to all other patient encounters.
  • Principle 10: Patients involved in a connected health encounter should be informed about the process, the inherent risks and benefits, and their rights and responsibilities, in compliance with applicable federal and state laws. Informed consent for connected health may not need to be independent from other informed consent for treatment, although mechanisms for obtaining electronic consent should comply with applicable federal and state laws.
  • Principle 11: The safety of patients and healthcare professionals must be ensured. Hardware and software compliance with safety and security standards, the appropriateness of a connected health approach to the situation, and demonstrated patient and provider user competency are essential components of safe connected health practice.
  • Principle 12: In order to inform connected health, and ensure the best outcomes, it is essential that the assessment, evaluation, and study of all aspects of connected health are ongoing and systematic. This research should include key stakeholders as primary informants and the resulting evidence utilized in the development and implementation of connected health guidelines and best practices.
  • Principle 13: Policies governing the practices and reimbursement of healthcare should be continuously updated and modernized to allow for the integration, national adoption, and sustainability of connected health.

Authored by Cindy Ebner, MSN, RN, CPHRM, FASHRM and Colleen Harris Marzilli, PhD, DNP, MBA, RN-BC, CCM, PHNA-BC, NEA-BC, FNAP