Telenursing refers to the use of information technology in the provision of nursing services whenever physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telemedicine, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, and telemonitoring. The field, however, is still being developed as the information on telenursing isn't comprehensive enough.
Telenursing is growing in many countries because of the preoccupation in driving down the costs of health care, an increase in the number of aging and chronically ill population, and the increase in coverage of health care to distant, rural, small or sparsely populated regions. Among its many benefits, telenursing may help solve increasing shortages of nurses; to reduce distances and save travel time, and to keep patients out of hospital. A greater degree of job satisfaction has been registered among telenurses.
Telenursing and nursing informatics
Nursing informatics, a branch of health informatics, has been defined by Judith Rae Graves and Sheila Corcoran as "a combination of computer science, information science, and nursing science designed to assist in the management and processing of nursing data, information, and knowledge to support the practice of nursing and the delivery of nursing care". Telenursing is a potential application of nursing informatics and as such, nursing informatics has served as a critical background concept its development.
One of the most distinctive telenursing applications is home care. For example, patients who are immobilized, or live in remote or difficult to reach places, citizens who have chronic ailments, such as chronic obstructive pulmonary disease, diabetes, congestive heart disease, or debilitating diseases, such as neural degenerative diseases (Parkinson's disease, Alzheimer's disease or ALS), may stay at home and be "visited" and assisted regularly by a nurse via videoconferencing, internet or videophone. Other applications of home care are the care of patients in immediate post-surgical situations, the care of wounds, ostomies or disabled individuals. In normal home health care, one nurse is able to visit up to 5-7 patients per day. Using telenursing, one nurse can “visit” 12-16 patients in the same amount of time.
A common application of telenursing is also used by call centers operated by managed care organizations, which are staffed by registered nurses who act as case managers or perform patient triage, information and counseling as a means of regulating patient access and flow and decrease the use of emergency rooms.
Telephone triage refers to symptom or clinically-based calls. Clinicians perform symptom assessment by asking detailed questions about the patient's illness or injury. The clinician's task is to estimate and/or rule out urgent symptoms. They may use pattern recognition and other problem-solving process as well. Clinicians may utilize guidelines, in paper or electronic format, to determine how urgent the symptoms are. Telephone triage requires clinicians to determine if the symptoms are life-threatening, emergency, urgent, acute or non-acute. It may involve educating and advising clients, and making safe, effective, and appropriate dispositions—all by telephone. Telephone triage takes place in settings as diverse as emergency rooms, ambulance services, large call centers, physician offices, clinics, student health centers and hospices.
Countries using telephone triage
An international telenursing survey was completed in 2005, reporting that the 719 responding full-time and part-time registered nurses and advanced practice nurses worked as a telenurse in 36 countries around the world. 68% were reported to be working in the United States, compared to only 0.6% in Finland. Some of these 36 countries include Australia, Canada, Norway, United Kingdom, New Zealand, Iran, Sweden, and the Netherlands.
In Australia, telephone triages are conducted in Western Australia, Australian Capital Territory, Northern Territory, Victoria and Queensland. The first telenursing triage was conducted in Western Australia in 1999, where Triage nurses would estimate patient complexity and refer them to Fremantle Hospital. Due to the remoteness of the Australian landscape it is vital that residents living in rural areas have access to clinical support and care. Telenursing allows nurses to overcome the barriers of distance and gives them the opportunity assist those who are unable to access health care clinics or services due to either the late hour or the distance.
Legal, ethical and regulatory issues
Telenursing is fraught with legal, ethical and regulatory issues, as it happens with telehealth as a whole. In many countries, interstate and intercountry practice of telenursing is forbidden (the attending nurse must have a license both in their state/country of residence and in the state/country where the patient receiving telecare is located). The Nurse Licensure Compact helps resolve some of these jurisdiction issues. Legal issues such as accountability and malpractice, etc. are also still largely unsolved and difficult to address. Ethical issues include maintaining autonomy, maintaining a patients integrity as well as preventing harm to a patient.
In addition, there are many considerations related to patient confidentiality and safety of clinical data.
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