Nursing Students' Perspectives on Telenursing in Patient Care After

Clinical Simulation in Nursing (2015) 11, 244-250 www.elsevier.com/locate/ecsn Featured Article Nursing Students’ Perspectives on Telenursing in Patient Care After Simulation Inger Ase Reierson, RN, MNSca,*, Hilde Solli, RN, MNSc, CCNa, Ida Torunn Bjørk, RN, MNSc, Dr.polit.a,b aFaculty of Health and Social Studies, Institute of Health Studies, Telemark University College, 3901 Porsgrunn, Norway bFaculty of Medicine, Institute of Health and Society, Department of Nursing Science, University of Oslo, 0318 Oslo, Norway KEYWORDS Abstract telenursing; Background: This article presents the perspectives of undergraduate nursing students on telenursing simulation; in patient care after simulating three telenursing scenarios using real-time video and audio nursing education; technology. information and Methods: An exploratory design using focus group interviews was performed; data were analyzed us- communication ing qualitative content analysis. technology; Results: Five main categories arose: learning a different nursing role, influence on nursing assessment qualitative content and decision making, reflections on the quality of remote comforting and care, empowering the pa- analysis tient, and ethical and economic reflections. Conclusions: Delivering telenursing care was regarded as important yet complex activity. Telenursing simulation should be integrated into undergraduate nursing education. Cite this article: Reierson, I. A., Solli, H., & Bjørk, I. T. (2015, April). Nursing students’ perspectives on telenursing in patient care after simulation. Clinical Simulation in Nursing, 11(4), 244-250. http://dx.doi.org/ 10.1016/j.ecns.2015.02.003. Ó 2015 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/). Over the past several decades, information and commu- 2011). Telenursing is one such proposed means of nication technology (ICT) in health care has become a improving health care globally (International Council of political priority worldwide (World Health Organization, Nurses, 2015). Kumar and Snooks (2011) define telenursing 2015), also in Norway (Ministry of Health and Care as ‘‘the use of telecommunications and information technol- Services, 2012). Because of a growing elderly population, ogy to provide nursing practice at a distance’’ (p. 1). increasing health care needs, and a shortage of skilled health There is a vast amount of research on the use of care workers, it is a pressing issue to identify ways in which telenursing, especially in caring for homebound, chroni- ICT can be used to meet the world’s health care needs cally ill patients (Kamei, Yamamoto, Kajii, Nakayama, & (Abbott & Coenen, 2008; Milligan, Roberts, & Mort, Kawakami, 2013; Lindberg, Nilsson, Zotterman, Soderberg, & Skaer, 2013; McLean et al., 2011). There is less research, however, on telenursing training. Although * Corresponding author: [email protected] (I. A. Reierson). the importance of integrating telenursing into nursing 1876-1399/Ó 2015 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. This is an open access article under the CC BY- NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). http://dx.doi.org/10.1016/j.ecns.2015.02.003 Nursing Students’ Telenursing Perspectives 245 curricula has been repeatedly stressed (Gallaghar-Lepak, telenursing in a simulated setting?’’ and ‘‘What are nursing Scheibel, & Gibson, 2009; Glinkowski, Pawlowska, & students’ reflections on the use of telenursing in patient Kozlowska, 2013; Grady, 2014; Husson, Zulkosky, care?’’ Fetter, & Kamerer, 2014), few studies have examined telenursing training during undergraduate nursing education. To our knowledge, there Methods are only two articles on Key Points this topic. Benhuri (2010) An exploratory, qualitative design was used (Polit & Beck, Nursing students designed telenursing simu- 2014) because little is known from former research studies viewed telenursing as lations for several home about telenursing at the undergraduate nursing education a new and exciting care nursing scenarios, level. Focus group interviews were used to collect data. nursing role. wherein students monitored We provide a brief description of the telenursing simulation Simulated remote and engaged in computer- scenarios. nursing care was ized text communication complex, and simulta- with simulated patients. Description of Telenursing Education neously integrating The author found that simu- communication skills, lating telenursing was Each student attended a 5-hour session completed in one subject matter knowl- important to make students day, which consisted of 2 hours of theoretical background edge, and technolog- comfortable with new tech- and 3 hours of simulating telenursing scenarios in the ical skill was nology, monitoring, and university college’s clinical simulation centre. The simu- challenging. remote nursing care. lation comprised three scenarios and was delivered using More knowledge is Tschetter, Lubeck, and real-time video and audio technology. The scenarios were: needed on best Fahrenwald (2013) reported (a) assisting a patient at home in colostomy management, practice telenursing on an ongoing telenursing (b) increasing staff competence at a rural nursing home in simulation in under- study in undergraduate the rehabilitation of a patient suffering from stroke graduate nursing nursing education. They sequelae, and (c) meeting family needs and assisting education. focused on using telehealth home care nurses in providing palliative care for a mother technologies to simulate with terminal stage breast cancer. All scenarios had nursing care in rural areas. High-fidelity simulations previously been reviewed and approved by clinical were integrated into each year of nursing education. experts. The students took the roles of patients, next of Remote monitoring was evaluated and documented in kin, and nurses; each student experienced the role of electronic health records. Student evaluations from the executing telenursing. The scenarios were simulated from first year of the intervention described the simulations as a variety of settings, including a home care nursing centre important to learning but that these simulations should (Scenario A), a rehabilitation centre (Scenario B), and a be provided more frequently. So far, no studies have exam- palliative care unit centre (Scenario C). Internet Protocol ined the simulation of telenursing scenarios executing (IP)-based video software enabled students via remote remote care via real-time video and audio technology, control to pan, tilt, and zoom an IP camera to obtain an which necessitates our study. optimal view of the patient’s situation. They had access to Simulation in nursing education has been a pedagogical a computerised decision support system on the perfor- approach for over a hundred years (Hyland & Hawkins, mance of practical skills in nursing service (PPS, 2011). 2009). It is viewed as an opportunity to train simulated Speech communication took place via intercom thus real-life scenarios in a safe environment and to practice sit- ensuring synchronised audio and video. There was a 10- uations that internships only offer to a limited degree minute briefing before each scenario, during which the (Jeffries & Battin, 2012; Ross, 2012; Tosterud, Hedelin, students prepared for their various roles and received in- & Hall-Lord, 2013; Williams & West, 2012). At the univer- formation on software use. Each scenario was planned sity college affiliated with this study, telenursing simulation to run for 20 minutes. A debriefing session was included has been part of the nursing curriculum since 2005. This after all three scenarios were completed. article presents the perspectives of undergraduate nursing students on the use of telenursing in patient care after Ethical Considerations they experienced three telenursing scenarios. The simulation session took place in the university college’s simula- The faculty dean at the university college gave institutional tion centre 2 weeks before the students’ graduation. acceptance for the study. The Norwegian Social Science Remote care was simulated via real-time video and audio Data Services gave verbal approval; written approval was technology. We sought answers to two research questions not necessary because we did not record personal informa- using an exploratory design and focus group interviews: tion, and the study was judged as comparable to students ‘‘How do nursing students describe their experiences with giving feedback on educational issues. pp 244-250 Clinical Simulation in Nursing Volume 11 Issue 4 Nursing Students’ Telenursing Perspectives 246 Sample 2004, p. 106), as opposed to latent content, which ‘‘involves interpretation of the underlying meaning of the text’’ (p. Following Malterud (2012), we selected a purposive sam- 106). To acquire an overall understanding of the data, the in- ple. One week before the simulation, students were terviews were repeatedly read, and comments, questions, informed via an e-learning platform that they would be and reflections were noted in the margins of the transcripts. asked to attend a focus group interview regarding their per- After this, each interview was organised into meaning units spectives on the use of telenursing. On the two simulation and further condensed. The condensed meaning units were days, all 59 bachelors of nursing

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