International Journal of Research ISSN NO:2236-6124

TELENURSING

Trilok Sompura,

Principal, Sharda College of Nursing,Pansar,

Gandhinagar,Gujarat.

Mail ID : [email protected]

INTRODUCTION: is an emerging field in nursing and gaining popularity. It refers to the use of technology in nursing to enhance patient care and involves the use of electromagnetic channel (e.g. wire, radio, optical) to transmit voice, data and video communication signals. Tele is a prefix meaning “at a distance” and it is used in terms such as telescope, or telemetry. The prefix tele, when combined with the scope, has the signal clear following means : an instrument to view phenomena at a distance . This has been used to describe many health care services such as telemedicine , , and Telenursing etc. The common denominators are distance and technology.

It is in practice, feasible and cost effective in developed countries like , US, Australia. In Indian scenario, Telenursing needs to be considered and should move side by side with telemedicine. Telenursing in which nurses deliver, manage, and coordinate patient care and services via telecommunication technology. It is one of the fastest growing area in the healthcare.

In India , Telenursing is in infancy stage required to be planned carefully , keeping in mind the quality of nursing practice, scope for monitoring and accreditation. The literature suggests the practice of Telenursing in developed countries is of a great success. It brings proximity to the nursing care, shorter hospitalization , reduce the workload when health organizations are facing acute shortage of nursing personnel. Though some forms of Telenursing the nurse can participate virtually in all the practice settings for the public health, family practice, outpatient department and emergency department for providing health services to the clients using protocols, use videoconferencing can monitor the early discharge patients over telephone, e-mails, develop website to provide health information.

Meaning:

Telenursing is a component of telemedicine.

• Telenursing is the branch of telehealth that involves actual nursing and client interaction through the medium of information technology.

• Offers health-related activities at a distance between two or more locations using information and communication technologies (ICT).

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• Tele - ―at a distance‖.

• Telenursing - ―care of patients at a distance

Evolution:

In the 1970s, several health maintenance organizations began utilizing nurses to give telephone advice—in the role that physicians once served.

Beginning in 1974 with Mary Quinn, who documented her care with patients at Logan Airport via telemedicine while she worked from a hospital in Boston, Massachusetts.

Since that time, creative nurses have used technology to advance healthcare in a variety of ways. Many advanced practice nurses are now leaders in Telenursing practice.

Definition:

1. Telenursing refers to the use of and information technology for providing nursing services in health care whenever a large physical distance exists between patient and nurse, or between any numbers of nurses. 2. Telenursing Definition from International Council of Nursing: Telenursing refers to the use of telecommunications technology in nursing to enhance patient care. • It involves the use of electromagnetic channels (e.g. wire, radio and optical) to transmit voice, data and video communications signals. 3. It is also defined as distance communications, using electrical or optical transmissions, between humans and/or computers. 4. Wikipedia “Telenursing refers to the use of telecommunications and information technology for providing nursing services in health care whenever a large physical distance exists between the patient and nurse”. 5. Telenursing is the use of telemedicine to deliver nursing care and conduct nursing practice. 6. Telenursing is the use of telecommunications technology in nursing to enhance patient care . It involves the use of electromagnetic channels ( e.g. wire, radio and optical ) to transmit voice , data and video communication signals. It is also defined as distance communications , using electrical or optical transmissions, between humans and or computers. International council of nurses(ICN) , 2001. 7. Telenursing is defined as nursing practice using the nursing process to provide care for individual patient or defined patient populations over a telecommunication devices( telephone, fax, electronic mail, , video conferencing ). 8. Telenursing is the delivery , management and coordination of care and services provided via telecommunications technology within the domain of nursing. 9. Telenursing is the use of telemedicine technology to deliver nursing care and conduct nursing practice. 10. Telenursing is the application to professional nursing practice.

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Types of telecommunication tools:

There are variety of telecommunication tools available to the nursing professional today, e.g. Teleservices,Telehealth, Telemedicine, Telenursing , Telephone nursing, Tele Home care.

1. Teleservices: Care services provided via telecommunication technology transmitting information from one site to another. This includes telephone consultations, Triaging and follow up. 2. Telehealth: It is the specific delivery of health care services over distances, utilising monitors, cameras and computers to achive improved patient outcomes. 3. Telemedicine: Medicine Practiced at a distance, including but not limited to , , , , and teleoncology. 4. Telenursing: Delivery of nursing care and services using telecommunications, a few examples may include interactive video, video monitoring, digital cameras. 5. Telephone nursing: This has been a reliable source for information to be shared between healthcare providers and patients. This process provided the building block for other Telenursing services. 6. Tele kid care: A telecommunication service for families of children with health issues.

REQUIREMENTS FOR TELENURSING:

1. Hardware: Telephone: The telehealth system is used via patient’s telephone system. A working phone must be available. The monitor is plugged directly into the phone and the phone is directed through the monitor so phone service is not interrupted. Telehealth hardware: The telehealth equipment consists of a monitor , electronic blood pressure cuff, pulse oximeter , scale, there is also EKG leads , video camera, blood glucose. Many companies are designing wireless versions of these pieces of equipment, this allows for ease of use and convenience for placement in a patient’s home. PC or laptop computer: The nurse must have access to a PC or laptop , with internet service available to access the patient data once it has been transmitted to the secure data base. 2. For Telehealth Monitoring:Depending on the needs of the patient the monitor should  Have vital signs measurement capabilities, pulse oximeter readings, glucose measurements and peak flows readings can be manually types into the monitor.  Each monitor can be programmed to provide personalized communication with the patient.  The monitor should be compact , lightweight and portable.  The readings of the monitor should easy to read. large print can be provided , some are voice prompted , the monitors are easy to use and user friendly.

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3. Software: The following are the software used in telehealth : operating system-Linux , National database. Security technology and firewalls and rewritable flash memory. - Operating system-Linux: Once the patient data is obtained it is sent to a secure website, one operating system that is used by Telehealth companies is The Linux system. This is an operating system such as windows XP, this is a free operating system that is accessible to anyone. - National database: A national database system that uses technology to ensure compliance and privacy standards is used. The nurse must have a user password to access the data. Patient information is stored at the database and can be accessed at any time by the nurse or physician via the website . Patient trending is also available. - Flash Drive: Data can be stored on a flash drive and transport by the patient to hospital . Once the patient is no longer using the system the monitor is reprogrammed via the database by the nurse. - Firewalls and other security devices: These are used to provide security and prevent information theft. 4. Software Programme: Cerner software a widely used software program by many healthcare facilities has established a clinical software system for healthcare called Cerner Beyond now. This software allows users to telehealth to view patient information in a single application. Creating an electronic consisting of demographies, vital signs, weight, blood sugar results, peak flow readings, questions and answers and clinical note entries. Another software programme utilized is Misys healthcare system which includes patient registration, discharge and updating patient information by the healthcare providers via computer access.

Telenursing technologies include activities such as • Videoconferencing, • Medical imaging and • Data transfer. Mobile telemedicine - Videoconferencing uses telecommunications of audio and video to bring people at different sites together for a meeting. This can be as simple as a conversation between two people in private offices (point-to-point) or involve several sites (multi-point) with more than one person in large rooms at different sites. Videophone calls (also: 'video calls' and 'video chat') differ from videoconferencing in that they expect to serve individuals, not groups. Webcams are popular, relatively low cost devices which can provide live video and audio streams via personal computers, and can be used with many software clients for both video calls and videoconferencing.

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How a videoconferencing can benefit people around campus: • Faculty member keeps in touch with class while away for a week at a conference. • Guest lecturer brought into a class from another institution. • Researcher collaborates with colleagues at other institutions on a regular basis without loss of time due to travel. • Schools with multiple campuses can collaborate and share professors. • Faculty member participates in a thesis defence at another institution. • Administrators on tight schedules collaborate on a budget preparation from different parts of campus. • Faculty committee auditions a scholarship candidate. • Researcher answers questions about a grant proposal from an agency or review committee. • Student interviews with an employer in another city. • Teleseminars. Videoconferencing first demonstrated in 1968.

Factors promoting the requirement for Telenursing: • Increasing shortages of nurses. • Costs of health care. • Need to provide Cost effective, timely and quality healthcare (remote, rural people). • Rise in Aging and chronically ill population.

TELENURSING – scope of practice Assistance to physicians in the implementation of medical treatment protocols. For E.g.) Immediate post-surgical situations (the care of wounds, atomies, handicapped individuals). Nurses can

as vital signs. -up care without the client having to travel to the health care agency for an appointment.

the historic audio exchange • Helps patients and families to be active participants in care, (self-management of chronic illness). • Home care – In normal home health care, one nurse is able to visit up to 5-7 patients per day. Using Telenursing, one nurse can ―visit‖ 12-16 patients in the same amount of time. • Immobile patients, patients with chronic or degenerative diseases are "visited" and assisted regularly by a nurse via videoconferencing, internet, videophone, etc. • Scope of practice • For educating the clients, • Nursing Teleconsultation,

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• Examination of results of medical tests and exams. • Telenursing is also used by call centres operated by managed care organizations which are staffed by registered nurses who act as case managers or perform patient triage, information and counselling as a means of regulating patient access and flow and decrease the use of emergency rooms.

Applications of Telenursing:The Telenursing can be applied in clinical practice, research and administration through - Telephone consulation , triage , follow up . - E-mail enquiries and advice. - Distance learning. - Video monitoring. - Digital photography.

Benefits of Telenursing:

- Enhance patient care. - Reduces travel time. - Increase productivity. - Access to speciality. - Enlarged educational opportunities.

Advantages of Telenursing:

1. With all of the new diseases and health issues emerging this is a way to learn faster in an effort to save lives and minimize risk or discomfort to the patient. 2. Helps to keep patients out of hospital. 3. Sharing valuable medical information with doctors and nurses in other countries around the world and in all areas of the profession. 4. Greater job satisfaction among tele nurses. 5. •Help solve increasing shortages of nurses. 6. Telenursing is cost efficient, timesaving and increases patient‘s ability to self- care. 7. Minimises the length of hospital stay. 8. Reduce distances and save travel time. 9. Improvement of resource and time allocation. 10. Another valuable way Telenursing can be of use is for military personnel. They are often times located in areas of the world that telemedicine is the only way to diagnose and treat them. 11. The fact is that Telenursing can go anywhere. It is both versatile and effective.

Disadvantages of Telenursing:

1. First of all, one problem is that many fear that it will take away from personal one on one time.

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2. Conferences and video can‘t replace valuable time between nurse and patient or more personal discussion that nurses and clients might otherwise have with each other. 3. Legal complications are raising another red flag. Laws and a set code of rules and ethics will first need to be applied before Telenursing can be used regularly in various capacities. This alone might take some time. 4. Services and how nurses get paid for them will all need to be resolved as Telenursing becomes a more fluent practice. This can prove to be a difficult determination. 5. Technical problems in 3-D imaging 6. Lack of standardisation and legislation 7. Problems in assessing qualifications 8. Problems with security and identification 9. Missing clinical anamnesis and examination 10. False diagnosis 11. Lack of ability to touch or direct delivery of care to a patient by nurse. 12. Technical skill is needed by nurses. 13. Network connection error / failure / delay. 14. Reliability of networks 15. Due to the risks involved with what is reliable vs. unreliable information and over dependence or over use of Telenursing can easily get out of control until more uniformed strategies and procedures are put into play. 16. Telemedicine is not yet all worked out where it can be utilized constantly or flexibly. 17. But, it has enormous potential to be a tremendous asset to the world and all its civilizations. 18. More time and effort will be needed to organize Telenursing for it to be confidently accepted.

Uses of Telenursing: Telenursing can be implemented in the following setting:

1. Home care agencies. 2. Hospices. 3. Hospital based telemedicine centres. 4. Managed care centres. 5. Rehabilitation centres. 6. All branches of military

Evidence Based Uses of Telenursing: Use of triage thus reducing the use of emergency rooms. Increase access to services to widely dispersed populations through internet, videoconferencing, videophone, E-mail consultation, short Messages services (SMS) in home nursing is especially useful.

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In Medical Surgical:

- For patients who are immobilized or live in remote or difficult to reach places, citizen elderly, children and adults with chronically conditions and debilitating illness such as Diabetes, COPD, Congestive heart failure, Neural degenerative disease etc. - Care of patients in immediate post-surgical situations, having wounds etc. - Nursing interventions to support mothers with difficult infants, reduce fatigue and distress. - Allow women with pregnancy –induced hypertension to remain at home.

Monitoring:

- Home monitoring of physiologic parameters such as blood pressure, blood glucose, respiratory peak flow, and weight measurement, taking a puse oximeter reading and visually assess via the internet and telephone from a base station. - Enables nurses to provide accurate and timely information and support online. - Examination of test results. - Monitoring of daily life and symptoms for home oxygen therapy clients.

Self-Management:

- Helps patients and families to be active participants in care, particularly in the chronic illness, changing of dressing, giving insulin injection.

Cost Effective:

- Reduces the requirement for, or the length of, hospital stay of patients and saves nurses time.

Professional Education:

- Helps to sharing Clinical information with national and international Experts. - Increases Access to nurse education, particularly for continuing education. - Clinical skills can be learned and practiced through patient simulation modelling. - Offers a doctorate in nursing completely via online distance education. - Provides opportunities for senior nurses to bring their years of experience back to the clinical area without enduring the burden of in hospitals. - Allows a nursing student to have contact with a clinical data repository, A faculty supervisor and the web. - To disseminate educational and other materials by using web.

Implications of Telenursing:

1. Delivery, Management, Coordination of Care: Nursing knowledge and processes are used to provide care to patients in many geographic areas.

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2. Multi-Disciplinary Teams: A multi- disciplinary team can use many technologies available to view and share patient information providing prompt and effective care. 3. Disease Management: Nursing care and the new innovative technologies can play a vital role in disease management and improving patient outcomes through client care.

Obstacle in Telenursing: The implementation of Telenursing may encounter following problems:

1. Patients and their family members may not be able to use home based equipment. Many patient may be having fear to use it. 2. Acceptance by patients who prefer to see health care providers face to face. 3. Initial cost outlay may be very high. 4. Privacy is an on-going concern. 5. Security of data is questionable. 6. May be difficult to track and proves for reimbursing providers.

Issues in Telenursing: When using the telehealth system staff must ne trained on proper use of safety and security guidelines to ensure protection of patient personal health information. When crossing state lines licensure must also be considered before utilizing the system. These are all issues that may arise and must be considered before implementing the system, the following are the issues that can arise in Tele nursing implementation.

1. Societal: Acceptance by society, patients, specialities, administrators and the government. 2. Technical: Telecommunication infrastructure. 3. Safety Standards: Standardizing certifying, Authenticating and registering Telenursing. 4. Regulatory Bodies: Credentialing and Certification. 5. Professional Liability: Administrative Liability and Civil Liability. 6. Professional: Safety and standards of practice, competencies by the regulatory bodies and the ministry of technology, Government of India. 7. Legal Issues: Privacy, Confidentiality and Data security. References:

1. ^ Edmunds, Marilyn W. (5 April 2010). "Telehealth, Telenursing, and Advanced Practice Nurses". MedScape. Archived from the original on 8 December 2010. Retrieved 23 June 2017. 2. ^ Nurses Happier Using Telecare, Says International Survey Archived 18 June 2006 at the Wayback Machine, eHealth Insider website, 15 June 2005, retrieved 4 April 2009; 3. ^ Graves, J. R.; Corcoran, S. (1989). "The study of nursing informatics". Image--the Journal of Nursing Scholarship. 21 (4): 227–231. ISSN 0743-5150. PMID 2807330. 4. ^ Kumar, Sajeesh; Snooks, Helen (9 July 2011). Telenursing. Springer Science & Business Media. ISBN 9780857295293.

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5. ^ GRADY, JANET L.; SCHLACHTA-FAIRCHILD, LORETTA. "Report of the 2004-2005 International Telenursing Survey". Computers, Informatics, Nursing. 25 (5): 266– 272. doi:10.1097/01.ncn.0000289163.16122.c2. 6. ^ Karabatsos, Georgia; Wilson, Andrew (June 2008). "Universal telenursing triage in Australia and New Zealand: A new primary health service" (PDF). Australian Family Physician. 37 (6): 476–9. 7. ^ Hutcherson, Carolyn M (30 September 2001). "Legal Considerations for Nurses Practicing in a Telehealth Setting". Online Journal of Issues in Nursing. 6 (3). Retrieved 12 May 2016. 8. ^ Hoglund, A; Holstrom, I. "Ethical Issues In Telenursing". International Hospital. Archived from the original on 4 June 2016. Retrieved 12 May 2016.

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