According to Kumar & Snooks (2011), telenursing is the use of information technology and telecommunications to deliver nurse services from a distance. Telenursing is mostly effected through call centers by registered nurses who regulate the access and flow of patients thus decreasing emergency room use. Home nursing also uses telenursing to help immobilized patients living in remote areas. Also, patients with chronic conditions get nursing care through the Internet, videoconferencing, and videophone, just to mention a few. Telenursing is critical in situations of nurses' shortage in healthcare facilities. It also reduces the distance between patients and healthcare providers and saves travel time, thus keeping patients out of the hospital. However, telenursing is apprehensive of potential ethical, legal, and regulatory issues that are inherent in telehealth in general. In addition to ensuring ethical and safe practice, telenursing practitioners also take into consideration the confidentiality and privacy of patient information. The paper will discuss telenursing advantages and disadvantages to the patient, address ethical and legal principles of the technology. The study aims to investigate whether telenursing is a tool that healthcare institutions use to keep the elderly and chronically ill patients from being readmitted.
Advantages and Disadvantages of Telenursing from a Patients' Perspective
Telenursing has many advantages to patients. First, patient's health needs are met by nurses using communication, information, and web-based systems. Telenursing is crucial in cases that need emergency primary care. Telenursing is safe for patients as they comply to triage recommendations. Secondly, it helps patients with urgent-health related issues who cannot access health services recommending emergency dispatch services. Telenursing reduces unnecessary transport of patients to the hospital especially in remote and rural areas. It also reduces overcrowding in emergency departments. Thirdly, telenursing is a faster way of helping patients in a major disaster, for example, large scale bio-chemical or nuclear attacks. In general, it reduces health and insurance spending as it decreases the total number of hospital visits.
The negative asects of using telenursing to patients are that it does not facilitate face-to-face communication. The information provided by the nurses is sometimes unclear leading to a lack of understanding by the patient. A major disadvantage to patients is the elimination of regular interactions with nurses and doctors. Patients require a personal connection with health providers to cooperate and trust them. Telehealth patient populations are mostly homebound; it is a strategy that moderates the length of stay in hospitals, thus a disadvantage to patients who may need to see a doctor. Lastly, the patient is limited to use hospital equipment.
Safety and Privacy
Research that relates to telenursing and telehealth practices shows great benefits that relate to diagnosis, consultations, monitoring, and surveillance of patients. Other benefits are in health and clinical outcomes related to technology advancements. However, the area has important safety concerns, particularly in patient safety. Telehealth is primarily a field that uses innovative technology to improve patient safety and care. However, there exist special concerns regarding the method of delivery of such services, with telehealth confidentiality being an issue. In addition, according to Roing, Rosenqvist, & Holmstrom (2013), the study on telenursing in Sweden shows significant problems in areas that affect patients. For example, there were findings on nurse malpractice, where nurses used insufficient activating strategies and open-ended questions. Also, according to the study, most patients complained of telenurses' way of communication.
Considering the confidentiality issues, telenurses have to use secure lines that assure confidentiality of patient information. However, it should be noted that there is an increasing threat to wireless technologies posed by computer viruses. In Sweden, telenurses use decision-making software programs to provide triage self-care advice and recommendations to the general public. Using a qualitative and descriptive approach, Holmstrom has interviewed twelve telenurses in Sweden. He thematically analyzed and transcribed the interviews. There were four findings namely; support for assessment and not for the decision, limited support for information and training, inconsistency between the decision aid software and the actual practice, and challenges in information and software programs. The findings are evidence-based and demonstrate that telenursing was not fully adapted in Sweden to the current clinical practice that focuses on acute conditions. Nurses were often working to a large extent providing self-care support that was sometimes over-riding the recommendations (Holmstrom, 2007).
Legal and Ethical Considerations for Practicing Nurses in a Telehealth Setting
The world is increasingly reliant on various technologies to manage information needs. However, many regulatory and legal questions about the provision of healthcare by use of technologies still remain. The legal issues associated with telehealth are divided into three categories. First, it falls in the traditional medico-legal issues that include the privacy and confidentiality of the health records. Secondly, it is the conflicts with state law that raises the issues of whether telenurses need a license to practice in remote states. Lastly, the unique telemedicine concerns are more on the reimbursement of services across the state lines. Telenurses must be licensed to be able to practice in states where they provide telehealth services. The scope of the practice and nurse accountability for the practice should be defined.
The experience of telenurses in Sweden shows that the decision support system inhibits the work of the nurses, but also is a quality improving program. The program simplifies the work of the nurses, gives them security, complements their experience, and enhances their credibility. However, it is also incomplete and sometimes conflicts with nurse opinions. The nurses have to apply policy values in relation to conflicting situations in order to conform to policy pressures (Roing et al., 2013). A central feature of telenursing is the lack of visibility due to the remote nature of consultations. Ethically, it impacts the skills to give and evaluate help.
According to Huibers, Keizer, Giesen, Grol, & Wensing (2012), nurses play a key role in telephone triage out of the hour's primary care. A significant percentage of the calls that the nurses handle are telephone advice alone. The scientists explored the determinants associated with this issue. The findings showed that an inter-nurse viability indicates a difference in perception of skills and tasks to handle telephone calls alone. According to Kumar & Snooks (2011), the software for telenursing triage recommends it to be more useful in the assessment than in decision making. It has limitations in supporting training and providing information for acute conditions. Respect for autonomy and obtaining informed consent can be difficult when an individual calls in for the patient. Respect of integrity is also difficult in both documentation and information processes. Balancing between the provision of honest patient information and conforming to the ethical demand is likewise an ethical demand that telenurses handle daily. Hence, moral discussions and competence development are a requirement and the basis for telenurses' practice.
The use of computerized decisions in telenurse practices is found to be both inhibiting and supporting. Telenurses in Sweden claim that the support system cannot replace the competence and knowledge of telenurses. For this reason, telenursing ought to be considered as complementary. Manuel should incorporate unique skills, knowledge, and competency regarding the use of telephone or electronic technology to efficiently help chronic and elderly patients.
Manuel has to evaluate the appropriateness of telenursing for the patient status. He must learn on information safety as well as control of the equipment. An evaluation of the reliability and the efficient use of the equipment are necessary. However, being compliant with nurse judgments is crucial for Manuel when telenursing. He must employ the nursing process wholly to acquire data, make assessments, and plans for healthcare through telephone encounters with patients. Lastly, Manuel must ensure that he meets the standards of care for quality, safety, and competent practice for telehealth nursing. He should practice in accordance with the American Nurses Association standards and scope of nursing practice.
Patients often contact healthcare through telephone, thus telenursing is a service in many Western countries. The ethical dilemmas in telenursing occur as it is sensitive to ethics. The inadequacy of research evidence focused on the patient safety in telehealth may partly be because of a lack of understanding on emerging security issues in telenursing and telehealth. The security issues associated with telenursing are complex in respect to malfunctioning equipment. There are concerns on potential adverse effects on decisions on patient management due to missing information, inaccurate findings, caregiver error, and misunderstood advice. Nonetheless, telenursing has proved to be time saving, cost efficient, and increasing patient self-care ability. Effective telenursing is a way for managing limited healthcare resources.
Holmstrom I. (2007). Decision aid software in telenursing: Not used as intended?
Experiences of Swedish telenurses. Nursing and Health Sciences, 9(1), 23- 28.
Huibers,L., Keizer, E., Giesen,P., Grol,R., & Wensing, M. (2012).Nurse telephone triage: Good quality associated with appropriate decisions.Family Practice,29(5),547.
Kumar, S., & Snooks, H. (2011).Telenursing. London: Springer.
Roing, M., Rosenqvist, U., Holmstrom, K. (2013). Threats to patient's safety in telenursing
as revealed in Swedish telenurses' reflections on their dialogues. Scandinavian Journal of Caring Science, 27(4), 969-976.