Telenursing Advantages, Ethics, and Future Practice

Introduction: Nursing in the Digital Age

Along with the Digital Age have come new requirements, new opportunities, new expectations, and new possibilities. Adaptation to 21st-century 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 discusses the advantages and disadvantages for the patient regarding telehealth and, more specifically, telenursing, as well as the legal and ethical principles that govern this technology for nurses.

Advantages of Telenursing for Patients and Providers

One advantage of telehealth is that it offers the nursing industry the ability to improve the quality of healthcare and save money at the same time. Simply put, e-medicine and telehealth are ways of sharing medical information pertaining to patients through the use of electronic and digital communication portals. Various technologies enable healthcare providers to use these means — from smartphones to email to virtual connections. Telehealth is bringing the 21st century to patient-provider relationships and helping providers more adequately and efficiently meet the individual needs of patients (Mayo Clinic, 2015). With attention given to patient safety, cost containment, managed care, disease management, shortages of healthcare providers, unequal access to healthcare, and the goal of helping the aging population remain functional in their homes, telenursing offers a great many positive opportunities to nurses and patients everywhere (Hebda & Czar, 2012, p. 509).

More advantages to telenursing include the many demands being voiced 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 services and today's technology, nurses have the potential to enable families and individuals to obtain care from home. A study by Trossman (2014) shows that the use of telemedicine in the ICU has proven successful in improving patient outcomes, decreasing readmissions, reducing patient mortality, shortening lengths of stay, and increasing cost savings for the hospital. Each of these findings 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, identified as part of the key to success in telenursing implementation in the ICU (Trossman, 2014). Thus, telenursing alone cannot create favorable outcomes, but when coupled with nurses who understand it and have the experience needed to communicate and assist, it can make a positive difference in the way nursing is conducted.

Collecting data is a skill that allows a professional nurse to combine critical thinking with clinical judgment. Searching for and selecting the desired information will impact the decisions made by the nurse whenever he or she uses telenursing. 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 — without them, telenursing would be a complete failure. Telenursing and telehealth are tools that can help nurses and healthcare providers do more and do it more efficiently in the 21st century.

Perhaps the biggest advantage to telenursing overall is that it can allow patients who dislike hospitals or making trips to see doctors to still be seen and monitored by a nurse remotely. E-medicine as a whole allows healthcare providers to be virtually omnipresent and alert to what is going on with patients in their own homes. This is vital: for instance, if an elderly person falls and needs attention but no one is aware of this, the person could die or go days before being discovered. With telenursing, the nurse can recognize that something is wrong immediately and communicate this concern to responders, who will reach the patient more quickly than could otherwise occur. As with all telenursing applications, this depends on the nurse having the right training and experience to respond appropriately.

Disadvantages and Barriers to Telenursing

Telenursing is not without its concerns. Many barriers — including reimbursement, licensure, organizational support, and policy gaps — have been major issues. Implementing telenursing at an office or healthcare facility raises the question of cost. Updating systems and allocating time and resources within a change management program can be energy-intensive and create budgetary concerns. Whenever new technology is developed, it raises concerns, and the cost of implementation and staff education can be viewed as disadvantages that outweigh the benefits.

A practical concern is that an emergency involving an elderly person at home might receive a slower response than if the patient had already been admitted to a hospital. This represents a second disadvantage: the removal of the nurse from the patient's physical location. Nurses may react unfavorably to the concept of nursing by remote control and view distance as a disadvantage to their duty of care.

The counterargument, however, is that there simply is not enough room in hospitals to accommodate every member of the elderly population. What telenursing offers is the ability for nurses to monitor patients from a distance and report immediately any signs of disturbance or emergency. Since not everyone can reserve a hospital room for immediate care, telenursing is a much better system than simply sending patients home with no monitoring at all. Telenursing essentially places the nurse in the home while preserving the patient's independence.

Another potential disadvantage is that telenursing could be considered an invasion of privacy. Some patients and clients may not be comfortable being watched on a monitor by someone miles away. There is also the concern that the system could be hacked and a live feed diverted to a third party who could exploit that access to violate a person's privacy. These ethical concerns can be addressed by clearly informing patients about the nature of telenursing. By obtaining informed consent, the nurse practitioner operates with transparency about the conditions, risks, and rewards of utilizing telenursing.

These issues are illustrated in practical experience. For example, when conflict broke out in the Middle East, the government deployed telemedicine to assist with care. Without sufficient discussions among policymakers regarding costs, system stability, legal issues, and efficient implementation, it was difficult to get the system up and running. With today's technology, telemedicine is capable of being instituted and utilized effectively; the lack of sufficient prior discussion was the primary concern (Lee, Lee, & Kim, 2016). Likewise, a study by Odeh (2014) found that uncertainty and a lack of knowledge about what telehealth is create a barrier to the development and transition of patients into telehealth programs. Clear communication is essential for implementing a strategic plan that builds staff confidence and is supported by strong technical infrastructure. A lack of education about how telenursing benefits the overall care picture is therefore one reason it is disadvantageous for some; overcoming this obstacle through education can turn it into an advantage and help make telenursing more popular and effective.