Telenursing: Is it in My Future? Along with the Digital Age have come new requirements, new opportunities, new expectations, and new possibilities. Adaptation to the 21st century's technology is part of what it means to be innovative -- and in the fast-moving modern world, if one is not innovative, one will soon be left behind. That is why it is important to recognize that telenursing is quite possibly in my future. Thanks to the rise of telehealth, cloud-sharing software, and the ease with which people can communicate over vast distances, the face of nursing is changing. There are of course negatives and positives to every change. This paper will discuss the advantages and disadvantages for the patient regarding telehealth and more specifically telenursing, as well as the legal and ethical principles for the nurse of this technology.

Advantages and Disadvantage

One advantage about telehealth is that it offers the nursing industry to ability to improve quality healthcare and save money at the same time. How is this possible? Simply put, e-medicine and telehealth are ways of sharing medical information pertaining to patients through the use of electronic/digital communication portals. Various technologies enable health care providers to use these means -- from smart phones to email to virtual connections, Telehealth is bringing the 21st century to patient-provider relationships and helping more adequately and efficiently to facilitate the provider in meeting the individual needs of the patient (MayoClinic, 2015). With attention given to patient safety, cost containment, managed care, disease management, shortages of healthcare providers, unequal access to health care, along with helping the aging population to be functional in their homes (without getting in the way by one's physical presence), telenursing offers a great many positive opportunities to nurses and patients everywhere (Hebda, Czar, 2012, p. 509).

However, telenursing is not without its concerning aspects. Many barriers including reimbursement and licensure along with support and policies have been major concerns. What will it cost to implement telenursing at an office or health care provider facility? Updating systems and allocating time and resources in a change management program can be consuming of energy and create budgetary concerns. Indeed, any time that new technology is developed it raises concerns and can be seen as a disadvantage even though it offers advantages in terms of being able to provide more. The cost of implementation and educating staff on how to use the technology can be viewed as a disadvantage that outweighs the advantages.

At the same time, a practical concern regarding telenursing is that an emergency, for example, with an elderly person, will occur that might have received faster response time had the patient already been in a hospital instead of in their own home, far from care. This can be viewed as a second disadvantage: the removal of the nurse from the physical location or presence of the patient, client or consumer. How will nurses react to this concept of nursing by remote control? They may react with an unfavorable opinion and view distance as a disadvantage to their duty as a nurse.

The only problem with this is that there simply is not enough room in hospitals to take in every member of the elderly population. What telenursing offers is for nurses to monitor from a distance and to report immediately any signs of disturbance or emergency that comes up. Since not everyone can reserve a room in the hospital for immediate care, telenursing is actually a much better system than simply sending patients home, where no one at all will be able to monitor them. Telenursing essentially puts the nurse in the home with the convenience being that the patient is still independent and on his or her own. The nurse simply watches in case anything comes up that needs immediate attention.

Another potential disadvantage of telenursing, however, is that it could be considered an invasion of privacy. Some patients and clients will not like that they are being watched on a monitor by someone miles away. Another disadvantage could be that the system may be hacked and the live feed diverted to a third party who could use that access to pry and break into a person's privacy. Thus, there are ethical concerns that need to be addressed with telemedicine. These issues can be addressed by alerting the patient/consumer about the nature of telenursing. By obtaining informed consent, the nurse practitioner is operating with transparency about the conditions of risk and reward of utilizing telenursing. This is being shown in practical experience. For example,...

Without having sufficient conversations and decisions made amongst policy makers regarding the costs, system stability, legal issues, and efficient implementation of telemedicine it was difficult to get up and to run. With the development of technology today, telemedicine is capable of being instituted and utilized, the lack of sufficient discussions is the concern with telemedicine (Lee, Lee, Kim, 2016). Likewise, the study by Odeh (2014) found that uncertainty and lack knowledge of what telehealth is causes a barrier to the development and transition of patients into telehealth programs. Clear communication is essential for the implementation of the development of a strategic plan to manage and ensure confidence in staff along with strong technical support. Thus, a lack of education about how telenursing is beneficial in the overall picture is one reason it is disadvantageous for some. Overcoming this obstacle through education can turn this obstacle into an advantage and help to make telenursing more popular and effective.
More advantages to telenursing are that many demands are being verbalized for better coordination of planning, implementation, allocation of resources and patient safety (Hebda, Czar, 2012, p. 523). Thanks to nurses' knowledge and experience with telehealth service and the technology today, nurses have the potential to enable families and individuals to obtain care from home. Also, a study by Trossman (2014) shows that the use of telemedicine in the ICU has proven to be successful in improving patient outcomes, decreasing readmissions, reducing patient mortality, shortening lengths of stay, and increasing cost savings for the hospital. Each of these shows that telenursing can be a great advantage when used with full knowledge and understanding. The use of knowledgeable/experienced nurses with critical thinking skills was, however, determined to be part of the key to success in telenursing implementation in the ICU (Trossman, 2014). Thus, telenursing itself is not possible to create favorable outcomes, but when coupled with nurses who understand it and who have the experience needed to communicate and assist, it can make a positive difference in the way that nursing is conducted.

Of course, collecting data is a skill that allows a professional nurse to combine critical thinking with clinical judgment. Searching for and choosing the desired information will impact the decision made by the nurse, whenever he or she uses telenursing (Chamberlain College of Nursing, 2015). Therefore, it is important to remember that just because monitors are used and telenursing is employed does not mean that qualified nurses are no longer needed. On the contrary, they are needed more than ever for without them, telenursing would be a complete failure. Telenursing and telehealth are tools that can help nurses and health care providers to do more and do it more efficiently in the 21st century. The Digital Age has given nurses a great many tools that they can use at their disposal, and telenursing is one.

Perhaps the biggest advantage to telenursing overall is that it can allow patients who do not like hospitals or making trips to see doctors to still be seen and monitored by a nurse via telenursing. Emedicine as a whole allows health care providers to be virtually omnipresent and alert to what is going on with patients in their own homes. This is very vital and important: for instance, if an elderly person falls and needs attention but no one knows of this, the person could die or go days before being discovered. With telenursing, the nurse can realize that something is wrong immediately and communicate this concern to responders who will check up on the patient more quickly than could otherwise occur. But as has been stated already, this all depends on the nurse having the right training and experience to understand how to respond via telenursing and make the appropriate decision at the time.

As far as legal and ethical concerns, it is important to remember that telenursing requires nurses to follow the same code of ethics that they follow in ordinary nursing activities and the same legalities are also in holding: they must be honest and accurate in their reporting, treatment and recording of data for the individuals. However, telenursing and emedicine help to make this easier because data can be instantly uploaded and stored via cloud-based software, so there is no more hassle about transferring records from one location to another or waiting weeks for information to come and then only to find that it has been lost or misplaced.…