Telemonitoring equipment in home care for chronic illness patients

Telenursing and Home Healthcare: The Advantages and Disadvantages of Telenursing

In the 1960s, Virginia Anderson, one of the most influential nurses in history, defined the unique functions of a nurse as that of assisting those who are sick as well as those who are well and performing different acts that contribute to health and its recovery. 55 years letter, Virginia would be impressed, considering the dramatic changes that the health care system has undergone, and how nurses have changed with the times in an effort to provide expert and cutting edge services to patients. Today, the nursing practice has fully embraced the contribution of technology in improving the delivery and quality of health care. Among the innovative ways nurse care has been improved, telenursing remains the most popular, particularly because it removed the geographical barriers that once existed between patients and healthcare providers.

By definition, telenursing is the application of information technology and telecommunications in the provision of nursing services to patients at a distance (Kumar and Snooks, 2011). It is a component of telemedicine - the use of medical information aimed at improving a patient's health status. Telemedicine was, in fact, first used in the 1960s at the time the National Aeronautics and Space Administration (NASA) successfully put astronauts in space. The astronauts still required medical care, which was telemetered from the spacesuits and the spacecraft during flights. Today, telemedicine has been accepted as an indispensable part of the healthcare sector. The American Telemedicine Association conducted an international Telenursing Survey and reported a total of 719 telehealth nurses in 49 states in the U.S. The top five consults include cardiology, mental health, dermatology, trauma care, and surgery. In light of the various concerns that have come up on the quality of home health care vis a vis that in professional institutions, this text evaluates telenursing in detail and takes a look at its advantages and disadvantages. It also evaluates the ethical implications of the practice and determines whether a career in this field would be advisable.

Telenursing and its application

Telenursing enables the nurses to carry out their duties through interactions with the client at a remote site. Through the use of electronic transmissions, they are able to administer therapeutic regimens and interventions to patients, receive information about their health status, and monitor the client's responses. For instance, in case a patient is diagnosed with chronic illness, telemonitoring equipment is installed into their homes and the nurses are able to monitor the patient's progress with the aim of detecting the problems the patient may have before being taken back to the hospital. Other applications of telenursing related to homecare include: caring for patients immediately after they have had surgery, caring for wounds, and taking care of handicapped persons (Kumar and Snooks, 2011).

Kumar and Snooks also state that telenursing call centers are the most frequently used modes of telenursing. These are staffed by registered nurses and operated by managed care organizations. In an effort to reduce the use of emergency rooms, the patients are able to prioritize the treatment of patients based on how severe their patients are, offer information to patients, and counsel them accordingly.

Other applications of telenursing include (Kumar and Snooks, 2011):

Uniting the efforts of nurses and monitoring them around the globe.

Availing training program to nurses remotely.

Training and assisting nurses in developing countries, as they may not have access to the required technology.

Ensuring soldiers in the battlefield have access to nursing care.

The advantages and disadvantages of telenursing

Advantages

Telenursing enables nurses to provide remote care to patients who might not have access to health facilities. They reduce the patient's burden of transport costs, reduce distances, and save travel time for both patients and nurses (Kumar and Snooks, 2011). Professional nurses are also able to consult other nurses who may be experts in different fields. Technology allows the sharing of this knowledge in a faster and more efficient way, ultimately improving the quality of nursing care the patients get. Telenursing acts as a solution to the increasing shortages of nurses. It enables them to assess the patients' situation and develop good plans of care for patients regardless of the distance, and at the same time provide follow-ups to plans of care that had been established before. It also makes it easier for professional nurses to collect data from remote sites, gain access to vast research populations, and attend peer conferences from anywhere in the world.

According to Sharpe (2001), the patients also benefit from telenursing in the following ways: they get personalized attention from the nurses, they save on transport costs, and they have better access to skilled professional nurses who are made easily available by the communication technology. Williams and his colleagues (2012) affirm this as they give an example of Baptist Health South Florida, a hospital in Miami, whose tele-ICU nurses have an average of 15 years experience, are experts at taking care of critically ill patients, and have good collaboration and communication skills.

Patients can also learn how to manage their conditions remotely from expert nurses. Technology makes interoperability possible as the nurse's efforts can be effectively coordinated from various locations and the managed care organizations and healthcare systems made to work together to ensure that patients are attended to in time and get the right quality of care.

Disadvantages

Telenursing does not lack its fair share of disadvantages. It has been accused of trying to replace personal services the nurses offer to the patients. By removing face-to-face communication, nurses are not able to interact with the patient at a personal level. The assessment done may also be limited as there lacks hands on access. According to William and his colleagues (2012), nurses have to deal with a variety of technological challenges. These include inevitable equipment malfunctions, software upgrades, and network interruptions. When these occur, the quality of health care is compromised and the health of patients may be put at risk. For example, when a patient is discharged from an acute care setting and these malfunctions occur, telenursing services will not help the patient get better - it will, in fact, expose them to more risk. Registered nurses are trained to use all their senses to assess a patient's environment and identify potential hazards. With the use of telephone services, this becomes impossible and some important details are overlooked.

Ethical issues in telenursing

Telenursing is fraught with regulatory, ethical, and legal issues (Kumar and Snooks, 2011). Professional nurses face numerous ethical dilemmas that arise from the use of technology. For instance, telenursing does not guarantee the confidentiality of patients as the electronic transmission of their personal information may lead to their privacy rights being infringed. There is also no legal liability when telenursing crosses set boundaries. Sometimes, telenurses have to talk to a relative when the patient is not in a position to communicate. There arises a conflict between the autonomy of the patient and that of the relative. Health care organizations may also sometimes compromise the quality of telecare in an effort to cut the costs associated with technology. In such instances where the principle of human dignity collides with cost efficiency, telenurses may suffer moral distress as they determine the best course of action.