Discussion: Telenursing and telemedicine

Discussion: Telenursing and telemedicine

Discussion: Telenursing and telemedicine

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Task:

Telenursing and telemedicine will only be successful if patients engage in the program. You have been asked by your manager to pilot a program aimed at improving transitions of care using the new telemedicine system recently implemented at your hospital. What are some of the ways that you can encourage both patient and provider engagement to ensure the pilot program success?

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 term scope, has the single clear following meaning: an instrument to view phenomena at a distance.¹ However, in health care, as in other arenas, the prefix tele often takes on several meanings. For example, the term telemetry is described as a process,² data,³ and an electronic device⁴ related to the task of remote measuring and reporting of information of interest. There is inconsistent and emerging nomenclature related to tele in health care.

The inconsistent use of language associated with the delivery and management of health care at a distance has made it even more difficult to distinguish the ontology of terms and describe their related safety and quality issues. Specifically, previous literature has used the terms telehealth, telemedicine, and telenursing somewhat interchangeably, and the few articles reporting safety concerns were difficult to cluster for further analysis.

Telenursing is the use of “technology to deliver nursing care and conduct nursing practice”⁵ (p.558). Although the use of technology changes the delivery medium of nursing care and may necessitate competencies related to its use to deliver nursing care, the nursing process and scope of practice does not differ with telenursing. Nurses engaged in telenursing practice continue to assess, plan, intervene, and evaluate the outcomes of nursing care, but they do so using technologies such as the Internet, computers, telephones, digital assessment tools, and telemonitoring equipment. Bearing in mind that health services now provided via teletechnologies have expanded, the term telehealth is used to capture the breadth of services. For the purposes of this review, the Health Resources and Services Administration defines telehealth as “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.”⁶ Telemedicine, the original term, is defined as the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, and education using interactive audio, visual, and data communications.⁷ The American Nurses Association has defined telenursing as a subset of telehealth in which the focus is on the specific profession’s practice (i.e., nursing).⁸

The delivery of telehealth care is not limited to physicians and nurses; it includes other health disciplines such as radiology, pharmacy, and psychology. These disciplines also deliver care using electronic information and telecommunications technologies and are accordingly called teleradiology, telepharmacy, telepsychology, and so forth. Although they are not the focus of this review, these disciplines are selectively included here for two reasons: (1) the safety issues associated with care delivered using electronic and telecommunications technologies are more similar than they are different among the various health disciplines, and (2) the dearth of research on safety and quality in the telenursing literature led the authors to include important research in other health disciplines. By including the research findings on safety and quality from varied health disciplines, the body of telenursing knowledge is expected to expand.