Telehealth Nursing

1. What Is Telehealth Nursing?

The National Council of State Board of Nursing (2014) stated, “The delivery of nursing services through the Internet or any other electronic channels constitutes the practice of nursing.” Telehealth nursing is not a new role; any nurse who has spoken with a patient over the phone has practiced telehealth nursing. However, advances in technology now allow nurses to see, monitor, and/or interact remotely with patients and patient devices.

The American Telemedicine Association defines telehealth nursing as “the use of telehealth/telemedicine technology to deliver nursing care and conduct nursing practice.” Other terms such as telenursing, telehealth nursing, and nursing telepractice are interchangeable. Telehealth is not a specialty area in nursing. Telehealth is employed by nurses in all settings who use telecommunications, such as video, audio, or integrated data in care delivery.

According to the ATA, this solution provides nursing care across a distance, empowering the care providers with the ability to monitor, educate, follow up, collect data, and provide multidisciplinary care, including remote monitoring, pain management, and family support in an innovative fashion. Agencies using telehealth reported having a patient-to-nurse ratio of 15:1, as compared with non-telehealth agencies having a ratio of 11:1. It can make a tremendous impact in rural or underserved areas where there is generally a shortage of nurses and healthcare services, as well as limited resources.

RNs play a critical role in the delivery of telehealth services. The development of the art and science of telehealth nursing practice has evolved, leading to expanded coordination of services and reduced patient risk, as well as contributing to care management models. The telehealth RN is responsible to provide nursing care in accordance with applicable federal requirements, state laws, nurse practice acts, regulatory standards, standards of professional ambulatory care nursing practice, and other relevant standards and organizational policies.

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2. Who Are Telehealth Nurses?

Registered nurses (RNs) and advanced practice nurses (APNs), such as certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists, utilize telehealth technologies in various clinical settings throughout the world. Telehealth nurses promote optimal wellness, participate in the management of acute illness, assist the patient to manage the effects of chronic disease, provide care coordination, and provide support in end-of-life care.

Across the nursing field, the use of telehealth is rising. As more hospitals and other medical facilities use telehealth to take their patient care to the next level, the role of telehealth nursing continues to evolve.

The following are characteristics of RNs utilizing telehealth services (American Academy of Ambulatory Care Nursing, 2018):

• Use knowledge and skills based on principles of the biological, physical, behavioral, and social sciences.
• Deliver holistic patient-centered care, with the promotion of optimal health outcomes throughout the lifespan and across the health-illness continuum.
• Demonstrate leadership knowledge and skills to support the clinical and administrative operation of telehealth interventions across practice settings.
• Use the nursing process when interacting with a patient during a telehealth encounter.
• Demonstrate an appreciation of the environmental context that encompasses culture, ethics, law, politics, economics, and access to healthcare resources when interacting with the patient.
• Design, administer, practice, and evaluate telehealth nursing services in accordance with relevant federal requirements, state laws, nurse practice acts, regulatory and accreditation standards, and institutional policies and procedures.
• Employ critical thinking and synthesis of objective and subjective data obtained during the assessment to identify priorities and care needs.
• Act as an advocate to advise, assist, and support patients in the optimal management of their healthcare, respecting their individual needs, health goals, and treatment preferences.
• Apply the provisions of the ANA Code of Ethics for Nurses to their own professional practice.
• Recognize signs and symptoms of an emergency and readily identify how to best support patients/families in the management of the emergency.
• Focus on patient safety and quality when applying appropriate nursing interventions.
• Pursue lifelong learning and maintain competencies for telehealth nursing.
• Employ clinical judgment and available evidence to expedite a nursing diagnosis and disposition.
• Assume accountability for coordination of care, including the use of delegation of telehealth activities to LPNs and UAP.
• Facilitate continuity of care using the nursing process, interprofessional collaboration, and coordination of the appropriate healthcare services and community resources across the care continuum.
• Participate in, contribute to, and/or apply research and evidence-based literature to improve the practice of telehealth nursing.

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3. Interprofessional Relationships

Telehealth nursing, while collaborative, is an independent nursing practice. There is often a misperception that the nurse functions as an agent of the provider, with the provider being responsible for the decision-making, which overlooks the significance of the nurse-patient relationship and fails to recognize the autonomy and responsibility of the RN. Collaboration should be a true partnership with the provider and patient in improving their quality of care.

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4. Practice Settings

Telehealth RNs practice by:

• Using clinical algorithms, protocols, or guidelines to assess patient symptoms and needs.
• Prioritizing the urgency of patient needs.
• Collaboratively developing the plan of care with the patient and supportive disciplines.
• Evaluating outcomes.

Professional RNs using telehealth technology, regardless of the specialty or setting, practice using the nursing process and evidence-based knowledge to guide their interactions. Additionally, the clinical role encompasses advocating for the patients and families, referring patients to health services across the continuum, health promotion and disease prevention education, and mediating secondary complications.

This clinical role may include performing appropriate independent nursing functions, consulting, and collaborating with the interprofessional team to develop a shared plan of care for optimal health outcomes. Professional telehealth RNs maintain accurate and timely documentation of care and keep other members informed of changes in the patient’s condition.

Telehealthcare spans primary care through acute care, chronic and disability care follow-up, and palliative care in end-of-life situations in a variety of settings. These telehealth practice settings include:

• Care Management/Care Coordination Centers
• Ambulatory Care
• Inpatient
• Home
• Prisons
• Government health systems, including military
• Urgent Care Centers or Emergency Departments
• Telehealth Service Centers
• Long-term care
• Schools
• Behavioral Health facilities
• Payers/Insurers
• Retail Clinics

Telephone triage, remote monitoring, and home care are the fastest-growing uses. Home telehealth nurses use systems that allow monitoring of patient data and physiologic parameters, such as oxygen levels, blood glucose, weight, blood pressure, and peak flow through an Internet connection or phone. Through the use of interactive video systems, patients can reach on-call nurses to address problems – for example, how to give an insulin injection or discuss weight gain. Telehealth call-centers use nurses to provide advice, triage patients, and provide education and counseling, to regulate access and flow to reduce ER visits. Telehealth nursing can also involve collaborating with healthcare providers in implementing medical treatment protocols and providing follow-up care.

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

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Support

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